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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600980
Report Date: 11/20/2020
Date Signed: 11/30/2020 03:25:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 141DATE:
11/20/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Freddie FullonTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Michael Garcia and Licensing Program Manager (LPM) Brenda Chan conducted an announced case management visit to this facility to provide a Technical Assistance (TA) regarding COVID-19. Due to COVID-19 pandemic, the visit was conducted remotely via video call. The TA visit was conducted with Freddie Fullon, executive director/administrator.

LPA discussed with Administrator the facility's COVID-19 infection control, mitigation and staffing plan.

According to Administrator, the facility currently has two (2) staff tested positive for COVID-19. Both staffs are isolating at home and being monitored. The facility is in contact with Department of Public Health (DPH) regarding mass testing which is scheduled to be on November 24th and November 25th. The facility has conducted contact tracing and surveillance testing according to the guidance of DPH. Staff and residents that were tested have negative test results for COVID-19. The facility plans to resume the surveillance testing of 25% of its staff every 7 days after two rounds of negative test results for all facility staff and residents.

A case management continuation is scheduled on Tuesday, November 24, 2020, at 1:00pm.

Licensing will be conducting daily calls to the facility to monitor its COVID-19 positive cases.

Administrator is to submit to LPA, via email, the facility's infection control, mitigation and staff plan within 24 hours.

Report was discussed with Administrator. An electronic copy of the report was emailed to Administrator for signature.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Michael GarciaTELEPHONE: (650) 380-4608
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2020
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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