421702848-2-13-2023-29-AS-JOLN-CP22LH-20230213162935

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421702848
Report Date: 02/13/2023
Date Signed: 02/13/2023 04:31:16 PM

Document Has Been Signed on 02/13/2023 04:31 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	COVENANT LIVING AT THE SAMARKAND		FACILITY NUMBER:	421702848
ADMINISTRATOR:	LAURIE SMALL		FACILITY TYPE:	741
ADDRESS:	2550 TREASURE DRIVE		TELEPHONE:	(805) 687-0701
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93105
CAPACITY: 379		CENSUS: 335	DATE:	02/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Linda Perez, Executive Director and Scott Bigler, Health Care Administrator		TIME COMPLETED:	04:45 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 Analysts (LPA's) Olson and Phillips conducted an unannounced infection control annual inspection. LPA's were greeted by Reception around 1:25 PM and Executive Director and Health Care Administrator around 1:40 PM. LPA's reviewed staff roster from around 2:30 PM to 3:15 pm LPA's Olson and Phillips took a physical plant tour of the facility with Executive Director and Health Care Administrator. This facility consists of Independent, Assisted and Memory Care Apartments. Main kitchen, dining rooms, Assisted Living and Memory Care were toured. The facility has a swimming pool and Spa. Swimming pool and spa is secured. The kitchen was inspected for cleanliness and sanitary condition. The facility has multiple areas spaced to accommodate as much space as possible for social distancing. The staff screen residents for symptoms and temperature as needed. Increased monitoring is conducted if any change of condition are noted or any residents are showing any signs, symptoms or a temperature. Signs are posted on the front door, entry area regarding masking and Covid-19. All staff wear face coverings in the facility and when on outings with residents. Facility have areas for visiting inside and outside. The facility also offers virtual and telephone communications to all residents in care. Residents and visitors are informed of the facilities infection control policies. New residents and staff will be tested and negative results received before working or residing in the facility. Continued on 809-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COVENANT LIVING AT THE SAMARKAND	FACILITY NUMBER: 421702848
	VISIT DATE: 02/13/2023

NARRATIVE

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The facility has procedures and plans for screening, isolation, testing, when to call 911 and notifying all responsible parties and agencies when needed.

Assisted Living Director and Infection Preventionist is in charge of infection control and provides training and education to staff, residents and visitors. Staff will use full PPE with N95 masks and face shields when dealing with any pending or confirmed cases of Covid-19. Facility has plans for delivering medications and meals to any quarantined/isolation resident rooms. Facility has a plan in place for when and whom to notify in an outbreak or other emergencies. Sinks were well stocked with soap, paper towels and hand washing signs. Staff and resident records are kept in locked offices. Facility does realize guidance changes and the most up to date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance.

At approximately 2:30 pm, LPAs reviewed Guardian/Department of Social Services, Community Care Licensing Division, Licensing Information System (LIS), Facility Personnel and facility staff roster and determined that all staff are criminal background cleared and associated to the facility.

No deficiencies were observed during the visit and all infection control requirements are being followed.

Exit interview conducted, report issued via email and printed.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC809 (FAS) - (06/04)

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