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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000389
Report Date: 10/30/2024
Date Signed: 10/30/2024 03:11:00 PM

Document Has Been Signed on 10/30/2024 03:11 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/
DIRECTOR:		GEORGES, NATASHAFACILITY TYPE:
740
ADDRESS:2426 GARFIELD AVETELEPHONE:
(916) 488-5722
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 325TOTAL ENROLLED CHILDREN: 0CENSUS: 191DATE:
10/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:52 AM
MET WITH:Natasha GeorgesTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On 10/30/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual inspection utilizing the care tool. LPA met with Executive Director and explained the purpose of the visit.

Today's census is 191 residents in care with eight residents on hospice services, facility is licensed for 325, hospice waiver of 20.

During today's inspection, LPA and Executive Director conducted a tour of the interior of the facility to ensure health and safety of residents in care. LPA and Executive Director conducted an inspection of facility kitchen, salon, theater room, laundry rooms, library, medication rooms, ten residents room, and the common areas. LPA observed facility to be at a comfortable temperature of 73*. LPA observed facility to have the required posters in the hallway by the common area. LPA observed facility to be clean and sanitary.

File review conducted for 12 residents records and 10 personnel records. LPA reviewed Facility's Emergency Disaster Plan 2024 and Elopement and Fire Drills. LPA observed documentation of quarterly drills conducted for 2024. At this time, LPA is requesting a copy of facility's liability insurance to be emailed to LPA by Friday November 8.

During room inspections, LPA and Executive Director observed sharps in R1's room. Additionally, LPA was informed if residents in care does not have mild cognitive impairment and/or dementia they are able to store own detergents. This matter will be under review.

No deficiencies cited.

Exit interview and a copy of the report was provided.
Anthony PerezTELEPHONE: (323) 485-4915
Cassie YangTELEPHONE: (916) 201-1928
DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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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