435202775-12-18-2020-26-AS-JROA-BWENWL-20201218094944

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435202775
Report Date: 12/17/2020
Date Signed: 12/18/2020 09:50:01 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:	ATRIA ALMADEN		FACILITY NUMBER:	435202775
ADMINISTRATOR:	SHEPODD, PAUL		FACILITY TYPE:	740
ADDRESS:	4610 ALMADEN EXPRESSWAY		TELEPHONE:	(502) 779-4700
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	240	CENSUS: 0	DATE:	12/17/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Paul Shepodd		TIME COMPLETED:	04:25 PM

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	Licensing Program Analyst (LPA) Joanne Roadilla conducted a pre-licensing tele-inspection visit today via Zoom. The Department has suspended on site visits due to COVID-19 shelter in place order by Governor Newsom. LPA met with Executive Director (ED) Paul Shepodd, Regional Vice President Jason Walthour, Project Director Operations Management Jordan Pope and Divisional Director of Care, Alisa Salluce. The facility is a 4-story building with Independent Living, Assisted Living and a Memory Care Unit. It has an approved fire clearance of 228 non-ambulatory residents and 12 bedridden residents for a total capacity of 240 residents. At around 2pm, LPA toured the facility virtually with ED and team. LPA observed COVID-19 related posters at the entrance to promote social distancing and infection control. A screening station was located at the lobby for checking temperature of any visitors, residents or personnel coming in through the facility. There were complaint, ombudsman, and resident's personal rights posters located by the mail room. The facility common areas and hallways were observed to be well lit and free of obstruction. Elevators used by ED during tour of the facility were observed operational. LPA observed the first-floor amenities including a restaurant, technology center, fitness center, salon and spa, etc. There was a fire extinguisher located near the bistro area that was last serviced on October 22, 2020. The first floor has 30 apartments for memory care residents. LPA inspected rooms #144 (private), #164 A & B (shared), #165 (furnished model unit) and #174 (private). The water temperature at rm #144’s bathroom was tested at 113.3 degrees F and the shared bathroom at rm #164 tested at 115.4 degrees F. Delayed egress doors by the stairs near rm #149 and rm #180 as well as by the patio leading out from the dining room of the memory care were tested and observed working. A laundry area next to one of the stairs was observed locked and only accessible to staff members. There was a swimming pool located near the fitness center that was observed gated and fenced. Continued on 809-C.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne Roadilla	TELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: ATRIA ALMADEN	FACILITY NUMBER: 435202775
	VISIT DATE: 12/17/2020

NARRATIVE

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At around 2:40pm, LPA inspected the 2nd floor. LPA observed the medication room and staff rooms located inside the Wellness centers. Room #s 202, 266 and 268 were randomly inspected. Rooms were well lit and windows in the bedrooms were observed in good working condition. Water temperature in rm #266’s kitchen was tested at 113.2 degrees F. The pull cord alarm in one of the bathrooms in rm #202 was tested at 3:05pm and LPA observed a pager that Alisa was carrying displayed the room number and time the cord was pulled.

At around 3:10pm, LPA inspected the 3rd floor. Room #s 302, 303 and 335 were randomly inspected. Rooms were well lit and windows in the bedrooms were observed in good working condition. Common areas and amenities including an art studio, a game room and a laundry room was observed with signs posted to promote social distancing.

At around 3:30pm, LPA inspected the 4th floor. An evacuation chair was observed in one of the stairwells. Room #s 428, 450 and 452 were randomly inspected. Rooms were well lit and windows in the bedrooms were observed in good working condition. Water temperature in rm #428’s kitchen was tested at 113 degrees F.

At around 3:50pm, LPA inspected the staff break room. LPA observed a large sofa which ED stated will be replaced with individual tables and chairs to accommodate more staff while also promoting social distancing.

At around 4pm, LPA inspected the kitchen and observed a food prep area, a walk in refrigerator and freezer displaying the appropriate temperatures and a storage area with at least 7 days of nonperishable food.

Component III orientation was conducted with the team. There were no issues noted during the pre-licensing tele-inspection. The physical plant is approved pending the completion of Centralized Application Bureau (CAB) review of the facility application. Exit interview conducted with and copy of report sent to Paul Shepodd to sign and mail back to CCL.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne Roadilla	TELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2020

LIC809 (FAS) - (06/04)

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