<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601015
Report Date: 10/27/2020
Date Signed: 10/28/2020 02:56:51 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:TROUSDALE, THEFACILITY NUMBER:
415601015
ADMINISTRATOR:CHU, SYLVIAFACILITY TYPE:
740
ADDRESS:1600 TROUSDALE DRTELEPHONE:
(650) 443-3700
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:140CENSUS: 108DATE:
10/27/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Sylvia ChuTIME COMPLETED:
03:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Michael Garcia 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 telephone and video call. The TA visit was conducted with Sylvia Chu, executive director/administrator, and Janet Hayes, BSN, RN of the California Department of Public Health.

According to Administrator, the facility currently has one (1) resident that tested positive for COVID-19. The facility conducted mass testing of staff and residents on October 21, 2020 and October 22, 2020. All staff and residents tested negative for COVID-19. A second mass testing will be conducted on October 28, 2020. The facility will 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.

LPA Garcia and RN Hayes discussed the facility's COVID-19 infection control and mitigation plan, along with the facility's staffing plan. Some parts of the facility were toured.

The visit resulted with the following recommendations:
- For all non-care staff to wear surgical mask while at the facility's premises.
- Post signage by the elevators and add floor marking inside the elevators to encourage social distancing.

Administrator is to email a signed and dated plan to LPA regarding the above recommendations within 24hrs.

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: 10/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1