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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600980
Report Date: 12/09/2022
Date Signed: 12/09/2022 01:08:37 PM


Document Has Been Signed on 12/09/2022 01:08 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:ATRIA AT FOSTER SQUAREFACILITY NUMBER:
415600980
ADMINISTRATOR:FREDDIE FULLONFACILITY TYPE:
740
ADDRESS:707 THAYER LNTELEPHONE:
(650) 532-2460
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY:216CENSUS: 161DATE:
12/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Executive Director, Freddie Fullon TIME COMPLETED:
01:20 PM
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On December 9, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual infection control inspection. LPA observed the COVID-19 signage posted at the front entrance. LPA signed in and was screened at entry point via digital screening monitor. LPA met with Executive Director, Freddie Fullon and explained the purpose of the visit. Executive Director was able to show LPA daily monitoring for staff, visitors, and residents on their digital system called Accushield which is also used to sign in and out.

LPA toured the facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a 6 floor facility; 1st floor being the entrance to the lobby, 2nd floor for Life Guidance (LG) residents, 3rd-6th for Assisted Living (AL) and Independent Living (IL). All floors have elevators. LPA observed elevators are level to the ground and easy access for residents with walkers and wheel chairs. LPA observed the dining room and lounge area on the second floor to be clean and free from any tripping hazards. During the visit, there was a Jewish spiritual gathering and residents were observed to be maintaining social distancing. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable. Dining room was observed to have tables 6ft apart from each other. Communal bathrooms on lobby and 2nd floor were equipped with liquid soap, paper-towels, and a trash can with a fitted lid. Wellness room was observed on the 2nd floor with PPE supplies and medication room was observed to be locked and inaccessible to residents.

Chemicals and toxins in LG has been secured in a locked cage and chemicals and and toxins in AL/IL are stored appropriately and inaccessible to residents. A comfortable temperature between 71-74 degrees F is maintained throughout the facility. LPA observed a total of five laundry rooms; 1 in the garage, 1 in LG, and 3 in AL/IL. According to the Administrator, only staff have access to the laundry rooms in the garage and LG. Residents in AL and IL bring their own detergent. Bleach is not allowed on facility premises. Overall, the community was clean, sanitary and odorless.

Infection control practices are observed: entry procedures, daily monitoring log for staff, residents and visitors, 30-day PPE supply, face coverings for staff, containment strategies, staff training and policies.

LPA requests the following forms to be submitted to CCLD by 12/16/22:
  • LIC308 Designation of Administrative Responsibility
  • LIC500 Personnel Report
  • LIC610E Emergency Disaster Plan
  • Administrator Certificate
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022
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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