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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202750
Report Date: 09/02/2021
Date Signed: 09/03/2021 10:11:21 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:MAGDALENE RESIDENTIAL CARE IIFACILITY NUMBER:
435202750
ADMINISTRATOR:LITERATO-HILARIO, FEFACILITY TYPE:
740
ADDRESS:1107 E. HOMESTEAD ROADTELEPHONE:
(408) 564-0423
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:6CENSUS: 3DATE:
09/02/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Fe Literato-HilarioTIME COMPLETED:
10:50 AM
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Licensing Program Manager (LPM) Sarah Yip, Licensing Program Analyst (LPA) Yatfai Eric Ng partnered with Health Facilities Evaluator Nurse (HFEN) Helen Shi from the California Department of Public Health, conducted a Case Management - COVID-19 - tele-visit via FaceTime, to provide a technical assistance to prevent and to mitigate the spread of COVID-19 at the facility. LPM, LPA, and HFEN met with the Licensee Fe Literato-Hilario.

LPM, LPA, and HFEN, and Licensee toured virtually with Licensee holding an electronic device showing around the facility. The tour started at the outside of the entrance. Only 1 entry and exit point for the facility. A screening station with thermometer, hand sanitizer, COVID-19 questionnaire, and sign-in sheet were observed. There were signs reminding everyone to cover his cough throughout the facility. Hand sanitizers were readily available in different areas. All staff in the facility wore masks at all time. 2 Restrooms were toured. Soap, paper towels, and trash bins with covers were readily available. Hand washing signs were posted. There was a designated visitation area for the visitors in the backyard to promote outdoor visitation.

The following infection control practices were suggested:
  1. To post COVID-19 related signs at the entrance.
  2. To post a sign at the gate of backyard to redirect visitor to the central entrance.
  3. To post a Provider Information Notices PIN 21-40-ASC to explain and to notify the visitors about the latest visitation guidance from the Department.
  4. To set up a Personal protective equipment (PPE) station with all supplies in each facility.
  5. To fix the broken paper towel dispenser and to affix a new one in the restrooms
  6. To remind everyone to properly adjust their masks to ensure the fit of the masks

Licensee stated the recommendations would be reviewed and implemented. No deficiency cited during visit. This report was emailed to the Licensee 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: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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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