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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202775
Report Date: 01/08/2024
Date Signed: 01/08/2024 07:11:40 PM


Document Has Been Signed on 01/08/2024 07:11 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:WATERMARK AT ALMADEN, THEFACILITY NUMBER:
435202775
ADMINISTRATOR:RONALD ELLENICHFACILITY TYPE:
740
ADDRESS:4610 ALMADEN EXPRESSWAYTELEPHONE:
(669) 258-4567
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:240CENSUS: 118DATE:
01/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Brenda RitterTIME COMPLETED:
07:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) David Marrufo and Steve Chang conducted an unannounced Case Management visit and met Executive Director (ED) Brenda Ritter. The purpose of the visit was to conduct a health and wellness check after the facility notified the Department that the facility had been out of electrical power since 01/06/2024.

During visit, LPAs toured the facility kitchen and observed emergency food and water supplies. LPAs observed that a food vendor was at the facility providing meals for residents.

LPAs observed the medication room and medication staff showed LPAs the online medication system that staff still had access to in order to administer medications. The facility still had internet access. The medication room staff showed LPAs the resident medication records that could be used in case the internet became inaccessible. Staff stated 2 out of 2 residents on hospice had had their hospice agency notified of the power outage.

ED stated residents had been provided with flashlights, lamps, and blankets. ED stated 36 residents had elected to stay with family members while the power was out at the facility. ED stated one resident who required oxygen had been moved temporarily with family.

LPAs conducted wellness checks with residents who were sitting in the lobby area. During visit, the backup generator began to fully provide power to the facility at around 6:30 PM. LPAs requested that a Plan of Action be submitted within 24 hours. During visit, facility staff created an LIC624 Unusual Incident Report on LPA Marrufo's computer. A copy of the LIC624 report was provided during visit.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with ED Brenda Ritter and a copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2024
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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