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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601015
Report Date: 12/08/2020
Date Signed: 12/09/2020 08:41:54 AM

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: 107DATE:
12/08/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sylvia ChuTIME COMPLETED:
04:45 PM
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On this date, Licensing Program Analyst Michael Garcia conducted a Case Management visit to provide Technical Assistance to the facility regarding COVID-19. Due to the pandemic, the visit was conducted remotely. The visit was conducted with Sylvia Chu, executive director/administrator, along with Rebekah Bird-Wohlgemuth MSN RN PHN of the California Department of Public Health.

The facility's COVID-19 infection control and staffing plans were discussed. The facility's screening area was toured, along with areas were staff and residents may congregate, including the memory care unit.

The visit resulted with the following recommendations:
- Include an additional screening for staff by end of each shift.
- Remove chairs that are not being used to foster social distancing.
- Ensure each trash bins have lids.
- Place social distancing signs/marking on couches.
- Place larger distance between tables at the staff breakroom.
- Place hand sanitizer outside the patio area near the door by the staff breakroom.

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

Report was reviewed and discussed with Administrator by end of visit.

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: 12/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2020
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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