<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202705
Report Date: 01/14/2021
Date Signed: 01/15/2021 05:24:45 PM

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:CRESCENT OAKSFACILITY NUMBER:
435202705
ADMINISTRATOR:SANDOVAL, GRACEFACILITY TYPE:
740
ADDRESS:147 CRESCENT AVETELEPHONE:
(408) 730-4004
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:44CENSUS: 15DATE:
01/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Grace SandovalTIME COMPLETED:
11:59 AM
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
Due to COVID-19 pandemic, Licensing Program Analyst (LPA) Yatfai Eric Ng partnered with a Health Facilities Evaluator Nurse (HFEN) Shahla Taleban from the California Department of Public Health, conducted a Case Management - Other - tele-visit via FaceTime, to provide a technical assistance to prevent and mitigate the spread of COVID-19 at the facility. LPA and HFEN met with the Administrator (ADM) Grace Sandoval.

LPA and HFEN toured virtually with ADM holding the telephone showing around the facility. The tour started at the entrance. There were signs reminding visitors to practice social distance. Only 1 entry and exit point for the facility. A screening station with gloves, face masks, hand sanitizer, and sign-in sheet were observed. Hand sanitizing stations were scattered in the facility. Trash bins were available throughout the facility. Staff in the facility wore gloves, masks, and face shields. Restrooms had soap and paper towels readily available.

The following infection control practices were suggested to prevent, contain, and mitigate the spread of COVID-19:
  1. Staff should avoid working in more than 1 facility to avoid transmitting the virus from 1 to another
  2. Contact local Department of Public Health to conduct N95 mask fit testing
  3. Switch all the open-trash bin to foot paddle trash bins
  4. Only use paper towel in common rest room for visitors or staff restroom
  5. Remove the chairs that are not in use; tape off the portion of the sofa that is not being in use

ADM stated the recommendations would be reviewed and implemented. No deficiency cited during visit.

This report was emailed to the ADM to review and to obtain a signature.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Yatfai NgTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1