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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000389
Report Date: 05/22/2024
Date Signed: 05/22/2024 01:05:56 PM


Document Has Been Signed on 05/22/2024 01:05 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:CRISTINA ORTIZFACILITY TYPE:
740
ADDRESS:2426 GARFIELD AVETELEPHONE:
(916) 488-5722
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:325CENSUS: DATE:
05/22/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:38 AM
MET WITH:Natasha GeorgesTIME COMPLETED:
01:15 PM
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On 5/22/2024, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility unannounced to conduct a required quarterly case management visit in accordance with the Stipulation and Order, effective date 06/01/2022 to 06/01/2024. LPA met with the Executive Director (ED), Natasha Georges, and explained the purpose of the visit.

During today's visit, LPA reviewed facility's stipulation binder and reviewed the orders of the stipulation. LPA observed facility audits of emergency call responses, care records and incident reports. LPA observed E-call testings to be completed for residents in care for month of April 2024. LPA observed last reporting of response call exceeding 10 minutes to be sent to Licensing on 5/17/2024. LPA observed in-service training regarding PHB, Valve Shut off- to be conducted on 5/9/2024. LPA observed the signatures of staff present.

LPA observed the facility to be clean, safe, sanitary and in good repair at all times. LPA observed the stipulation to be posted in a conspicuous space.

LPA and Executive Director discussed the upcoming end of facility's probation term. LPA informed Executive Director once probation has ended, a new facility license will be generated and mailed to the facility.

As a result of today's visit, LPA observed the facility to be in compliance to Stipulation and Waiver and Order.
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: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2024
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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