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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200989
Report Date: 01/06/2021
Date Signed: 01/06/2021 10:15:08 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:BRIDGEPOINT AT LOS ALTOSFACILITY NUMBER:
435200989
ADMINISTRATOR:MARIA QUINTEROFACILITY TYPE:
740
ADDRESS:1174 LOS ALTOS AVENUETELEPHONE:
(650) 948-7337
CITY:LOS ALTOSSTATE: CAZIP CODE:
94022
CAPACITY:150CENSUS: 99DATE:
01/06/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria QuinteroTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) David Marrufo and HFEN Nurse Emma Erickson conducted a tele-visit via Zoom to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility. LPA Marrufo, and HFEN Emma Erickson met with Administrator Maria Quintero.

The Administrator reports that there are currently 3 COVID-19 positive residents and 5 COVID-19 positive staff.

During today's tele-visit, the following recommendations were made to the facility by HFEN Maria Quintero:

1. Staff should not use surgical masks underneath N95 masks
2. Gowns should be stored before use and not reused. Gowns should be disposed before leaving isolation rooms.

No deficiencies were cited as per California Code of Regulations, Title 22.

This report was reviewed with Administrator Maria Quintero. A copy of the report will be sent to her for it to be signed and returned to CCL.
SUPERVISOR'S NAME: George NwaforTELEPHONE: (408) 324-2116
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2021
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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