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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201557
Report Date: 02/09/2021
Date Signed: 02/23/2021 08:59:33 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:PRUNERIDGE RESIDENTIAL CARE HOMEFACILITY NUMBER:
435201557
ADMINISTRATOR:CORTES, LEILANIFACILITY TYPE:
740
ADDRESS:3030 PRUNERIDGE AVENUETELEPHONE:
(408) 247-2771
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:6CENSUS: 4DATE:
02/09/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Leilani CortesTIME COMPLETED:
01:40 PM
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Licensing Program Analyst Joanne Roadilla and Health Facilities Evaluator Nurse (HFEN) Angela Pruitt from the California Department of Public Health, conducted a tele-visit via Teams Meeting to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility. LPA and HFEN met with Licensee Leilani Cortes.

At around 1:10pm, LPA/HFEN virtually toured the facility. COVID-19 related postings were visible at the entrance of the facility. There was a screening station by the garage door located at the side entrance which was the designated central entry point of the facility. There were 4 staff present (2 regular staff and 2 temporary staff) and all were observed wearing masks and face shields.

HFEN recommended the following areas of infection control practices to prevent, contain, and mitigate the spread of COVID-19 at the facility:
(1) Make sure thermometer and screening log is kept in the screening area of the facility.
(2) Place supplies of N95 masks and gowns outside of the isolation room.
(3) Place a covered trash bin inside the isolation rooms for doffing gowns after use. It is recommended to use foot operated covered trash bins especially in isolation rooms to avoid cross contamination.

No deficiencies cited during today's tele visit. This report was discussed with and a copy emailed to Leilani Cortes for signature.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne RoadillaTELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2021
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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