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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005251
Report Date: 04/19/2022
Date Signed: 04/20/2022 10:30:58 AM


Document Has Been Signed on 04/20/2022 10:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ATRIA CARMICHAEL OAKSFACILITY NUMBER:
347005251
ADMINISTRATOR:HAGEN, KIMBERLYFACILITY TYPE:
740
ADDRESS:8350 FAIR OAKS BLVDTELEPHONE:
(916) 944-2323
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:95CENSUS: 155DATE:
04/19/2022
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Barbara Fleck, AdministratorTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Sabrina Calzada and Regional Manager (RM), Alycia Berryman arrived announced to participate in a scheduled inspection with the Healthcare-Associated Infections (HAI) Program. LPA and RM met with Kristy Trausch, CII and Sheila Gonzaga, Sacramento County Public Health, Barbara Fleck, Administrator and a facility corporate staff member. LPA and RM met the other participants in the facility lobby and were advised the inspection scheduled at 8:30 am had just finished. LPA and RM explained they had to be tested and cleared in the regional office prior to arriving on site. Additionally, LPA and RM completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms, applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE): N95 mask.

Kristy Trausch, CII stated that she found the facility to be practicing effective Covid-19 infection prevention protocols and suggested that facility staff increase disinfection and change masks when appropriate.

LPA provided multiple PPE supplies to the facility at the conclusion of today's inspection.

There are no deficiencies issued during today's inspection.

This report was emailed to the facility Administrator on 4/20/2022 for signature.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022
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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