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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 03:20:25 PM

Document Has Been Signed on 10/30/2024 03:20 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:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:13 PM
MET WITH:Natasha GeorgesTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 10/30/2024, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to conduct a case management follow-up visit in regards to the visit conducted on 9/20/2024.

LPA met with Executive Director, Natasha Georges and explained the purpose of the visit.

During today's visit, LPA and Executive Director discussed the closure of the death report visit as R1 was found unresponsive during a meal check as facility has a policy of checking on residents in care if a meal was missed. LPA observed R1 to have POLST with "do not resuscitate".

No deficiencies observed.

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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