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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000389
Report Date: 10/20/2023
Date Signed: 10/20/2023 04:37:17 PM


Document Has Been Signed on 10/20/2023 04:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:ATRIA EL CAMINO GARDENSFACILITY NUMBER:
347000389
ADMINISTRATOR:KIMBERLY HAGENFACILITY TYPE:
740
ADDRESS:2426 GARFIELD AVETELEPHONE:
(916) 488-5722
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:325CENSUS: 192DATE:
10/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Kim HagenTIME COMPLETED:
04:45 PM
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Licensing Program Analysts (LPAs) Cassie Yang and Cheyenne Ratajczak arrived unannounced at the facility to conduct a required 1-year annual inspection. LPAs met with Senior Executive Director (ED), Kim Hagen , and explained the purpose of the visit.

Facility is licensed for 325 non-ambulatory residents, hospice waiver of 20. Facility currently has 192 residents, 11 on hospice services.

LPAs and ED conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: eleven (11) rooms in Memory Care/ Life Guidance unit, nine (9) rooms in Assisted Living, three (3) laundry rooms, two dining rooms, Salon, Movie Theater, Library, kitchen, mini Grab & Go Grille, Learning Center, Employee Lounge, and the courtyard. LPAs observed the facility to have the mandated posters posted in a conspicuous space.

LPAs observed Administrator Certificate for ED to be expired. ED informed LPAs her certificate has been renewed but did not receive the copy. LPAs confirmed on CCLD website, Administrator Certificate #6050074740 is current with expiration date of 12/07/2024. LPAs informed ED LPA Yang will contact Admin Cert unit for a copy of ED's certificate. In areas toured, LPAs did not observed any violation of health, safety and personal rights.

LPAs completed the CARE tool and found the facility to be in compliance at this time. No deficiencies observed.

Exit interview conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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