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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202636
Report Date: 10/05/2021
Date Signed: 10/05/2021 04:52:48 PM

Document Has Been Signed on 10/05/2021 04:52 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, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:MURIEL WRIGHT RECOVERY CENTER CRTFACILITY NUMBER:
435202636
ADMINISTRATOR:JENNIFER BRISCOEFACILITY TYPE:
772
ADDRESS:298 BERNAL ROAD STE ATELEPHONE:
(408) 638-4744
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY: 15CENSUS: 9DATE:
10/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Hollie Limbocker & Blanca GarciaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Yatfai Eric Ng conducted an unannounced infection control site visit. LPA met with the Office Coordinator Hollie Limbocker and Interim Clinician Director Blanca Garcia.

One central entry point was designated for all staff, residents, and visitors. A temperature screening station with thermometer and sign in sheet were present at the entrance. LPA was temperature checked before entering.

LPA toured the facility. The facility was observed to be in sanitary condition and in comfortable temperature. All staff members were wearing masks. There were COVID-19 signs and hand sanitizers at the entrance and throughout the facility. The facility and high traffic areas were sanitized at least 3 times a day.

LPA inspected 4 restrooms. The restrooms were observed to be adequately stocked with paper towels and hand soap. Hand washing signs were present. There was an adequate supply of personal protective equipment in the storage areas.

A plan for epidemic outbreak specific to COVID-19 mitigation plan report (LIC 808) from the facility was submitted and approved by the Department. LPA discussed the infection control and reviewed the current Provider Information Notice PIN 21-40-ASC with Interim Clinician Director. Residents were COVID-19 tested before being admitted. All staff exception 2 having exemptions were fully vaccinated. Vaccination would be provided to new residents continuously.

An advisory note was issue. No deficiency cited during visit.

This report was reviewed with Interim Clinician Director. A copy of this report and advisory note were provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Yatfai Ng
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2021
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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