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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202775
Report Date: 06/09/2021
Date Signed: 06/09/2021 03:52:00 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:ATRIA ALMADENFACILITY NUMBER:
435202775
ADMINISTRATOR:SHEPODD, PAULFACILITY TYPE:
740
ADDRESS:4610 ALMADEN EXPRESSWAYTELEPHONE:
(916) 221-8126
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:240CENSUS: 38DATE:
06/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Charmaine VeradorTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joanne Roadilla conducted an unannounced Case Management visit today. LPA met with Resident Services Director (RSD) Charmaine Verador and Memory Care Director (MCD) Antoine Rabbat.

The purpose of the visit was to follow up on a report received by the Department on 06/09/21 regarding an alleged verbal abuse by a staff towards a resident (R1).

At around 3pm, LPA interviewed RSD, MCD and resident's family member. LPA reviewed and obtained R1's physician report, Appraisal/Needs and Services Plan and Functional Capability Assessment.

Based on the report and interviews, on 06/06/21 at 4pm, a care staff (S1) was witnessed speaking to R1 in a verbally scolding manner which was captured through a virtual (video) chat platform. S1 was ordering R1 in a disrespectful tone of voice when R1 needed assistance with activities of daily living (ADLs). The care staff (S1) involved is not present in the facility and has been suspended since the incident.

A deficiency was cited today in accordance with the California Code of Regulations, Title 22, see LIC809-D. Citation, Plan of Correction, and Appeal Rights were discussed and a copy of reports provided to Antoine Rabbat, MCD.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne RoadillaTELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021
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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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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2021
Section Cited

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87468.2 (a) In addition to the rights listed in Section 87468.1…residents in...residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation...intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidence by:
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Based on report and interviews, a care staff (S1) was witnessed by family member being verbally abusive towards R1. S1 scolded and ordered R1 in unacceptable and unprofessional conduct when assisting R1 with ADLs. This poses a potential health and safety risk to client in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne RoadillaTELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2021
LIC809 (FAS) - (06/04)
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