Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005464
Report Date: 11/12/2020
Date Signed: 11/12/2020 03:59:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:CARLTON PLAZA OF ELK GROVEFACILITY NUMBER:
347005464
ADMINISTRATOR:AMANDA SMITHFACILITY TYPE:
740
ADDRESS:6915 ELK GROVE BLVD.TELEPHONE:
(916) 714-2404
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:180CENSUS: DATE:
11/12/2020
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Amanda SmithTIME COMPLETED:
02:44 PM
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An Office conference call was conducted today in the Sacramento Regional Office via Webex Meetings. The purpose of this office meeting is to discuss the COVID outbreak.

Present in the meeting is Regional Manager Krystall Moore, Program Clinical Consultant Supervisor Myra Cunana, Licensing Program Manager Stephen Richardson, Licensing Program Analyst Suong Teh , Department of Public Health nurse Isabele Miller, facility Executive Director Amanda Smith, and Vice President of Clinical Operation Marcos Santos.


Issues discussed during the meeting were:
  • Assigning an Infectious Control Lead
  • Co-horting plan
  • Visitation

The facility has stated they will do the following to achieve continued and substantial compliance:
  • Submit staff schedule to licensing monthly/weekly and provide updates as changes occur.
  • Create a mitigation plan to include the infection control nurse and future plans for cohorting.

The facility is doing visitation via window visits, telephone calls and virtual visits. Visits are restricted except for essential visitors. The facility has designated staff to work with the positive individuals, not working with non-positive individuals and has a designated break room.

At this time, no deficiencies are cited. An exit interview was conducted with all mentioned representatives via Webex meetings and a copy of this report will be provided to the facility via email. A copy must be signed and returned to Community Care Licensing (CCL) and the one copy is to be retained by the facility
SUPERVISOR'S NAME: Krystall MooreTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6803
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2020
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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