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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202775
Report Date: 02/08/2021
Date Signed: 02/17/2021 10:18:45 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 ALMADENFACILITY NUMBER:
435202775
ADMINISTRATOR:SHEPODD, PAULFACILITY TYPE:
740
ADDRESS:4610 ALMADEN EXPRESSWAYTELEPHONE:
(916) 221-8126
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:240CENSUS: 18DATE:
02/08/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Paul ShepoddTIME COMPLETED:
11:30 AM
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Licensing Program Analyst Joanne Roadilla and Health Facilities Evaluator Nurse (HFEN) Barbie Henson from the California Department of Public Health, conducted a tele-visit via Teams Meeting to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility. LPA and HFEN met with Executive Director (ED) Paul Shepodd.

At around 10:15am, LPA/HFEN virtually toured the lobby area, dining room, outdoor courtyard designated as the visitation area, assisted living and the memory care (MC) unit. COVID-19 related postings were visible throughout the facility. There was a screening station located at the lobby, hand sanitizers were observed in common areas of the facility and social distancing guidelines are being implemented. Staff were observed wearing masks and face shields and practicing social distancing. ED stated high touched surfaces are disinfected as often as once per hour and bathrooms are cleaned/disinfected every four hours.

HFEN recommended the following areas of infection control practices to prevent, contain, and mitigate the spread of COVID-19 at the facility:
(1) Prepare an isolation cart with PPEs to utilize if there is a positive case at the facility including a STOP sign and PPE sequencing (donning/doffing) signs to be posted outside isolation room(s).
(2) Recommended to use foot operated covered trash bins especially in isolation rooms to avoid cross contamination.
(3) Designate an area/wing at the facility for isolation of any resident who tests positive.
(4) Set up a screening area right at staff entrance prior to staff going up to the lobby of the facility to mitigate spread of COVID-19 in case staff coming to work is symptomatic.

No deficiencies cited during today's tele visit. This report was discussed and a copy emailed to Paul Shepodd for signature.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne RoadillaTELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2021
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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