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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294299
Report Date: 01/14/2021
Date Signed: 01/19/2021 10:58:19 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:MERIDIAN MANOR 2 LLC (RCFE)FACILITY NUMBER:
435294299
ADMINISTRATOR:MAGNO, DAVEFACILITY TYPE:
740
ADDRESS:5486 YALE DRIVETELEPHONE:
(408) 532-7304
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:3CENSUS: 3DATE:
01/14/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Dave MagnoTIME COMPLETED:
02:10 PM
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Licensing Program Analyst Joanne Roadilla and Health Facilities Evaluator Nurse (HFEN) Mirabelle Villamin 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 Administrator Dave Magno.

COVID-19 postings were visible throughout the facility. HFEN did not find any areas of concern with infection control practices to prevent, contain, and mitigate the spread of COVID-19 during the tele-visit.

ADM reported that they are back to conducting surveillance testing of staff. HFEN advised ADM that staff who tested positive and have completed their isolation period do not need a re-test for COVID-19 for at least 90 days.

No deficiencies cited during today's tele-visit. Report was discussed with and a copy sent to Dave Magno to sign and mail back to CCL.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne RoadillaTELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
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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