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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005251
Report Date: 07/22/2022
Date Signed: 07/22/2022 01:53:02 PM


Document Has Been Signed on 07/22/2022 01:53 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
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: 75DATE:
07/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Barbara FleckTIME COMPLETED:
02:15 PM
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On 7/22/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a required annual. LPA met with Barbara Fleck, Executive Director, and explained purpose of the inspection. Before today's inspection, LPA completed required COVID-19 testing protocols and completed daily assessment. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. The facility is licensed for (95) residents and has a hospice waiver for (15). There are (1) residents currently on hospice. There are (19) residents in memory care unit, the facility is licensed for (20).

LPA and Executive Director toured the interior of the facility including the Assisted Living Unit, Memory Care Unit, laundry, library, staff break room, restrooms, salon, and common areas including the lobby area. In areas toured, LPA observed the facility to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed paper towels, soap and trash cans with a lid. Inside temperature was observed to be 73* F. LPA toured the kitchen and observed 2+ day perishable and 7+ day nonperishable food. LPA observed the Administrator Certificate posted (Barbara Fleck #6041744740) to be expired 7/21/2022. Executive Director provided proof of renewal to LPA, mailed to CDSS on 5/23/2022. LPA observed the fire extinguishers to be last serviced 1/18/2022.

LPA requested an copy current liability insurance during today's inspection by Friday 7/29/2022.

There were no deficiencies observed during today's inspection.

Exit interview. Copy of report left at facility with Executive Director.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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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