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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294328
Report Date: 09/10/2020
Date Signed: 09/10/2020 02:06:18 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:VILLA FONTANAFACILITY NUMBER:
435294328
ADMINISTRATOR:DUEWEL, MA. FELICITAS V.FACILITY TYPE:
740
ADDRESS:5555 PROSPECT ROADTELEPHONE:
(408) 255-5555
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:104CENSUS: 74DATE:
09/10/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Marife DuewelTIME COMPLETED:
11:33 AM
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Licensing Program Analyst (LPA) Gladys Kuizon conducted a Case Management tele-visit today. Due to COVID-19 preventive measures, facility visits have been suspended. LPA met with Administrator Marife Duewel. Also present during meeting were LPAs Steven Chang, Grace Davis, and Steve Nguyen.

The purpose of this visit was to conduct a facility tour to ensure that facility is continuing to adhere to COVID-19 infection control guidelines and preventive measures.

At 11:08 AM, LPAs toured the facility. LPAs observed staff transporting an enclosed steel food cart from the kitchen to the Memory Care unit. Staff was observed handing the food cart over to another staff at the Memory Care unit's entrance.

COVID-19 postings were observed in conspicuous areas of the facility. Hand sanitizers were observed available in the premises. Social distancing was observed during LPAs' tour. No residents were in quarantine due to COVID-19 during tele-visit.

LPA Kuizon advised Administrator to continue to communicate with the Santa Clara County Health Department (SCCHD) and CA Department of Public Health (CDPH) for the most recent COVID-19 guidelines. Per Administrator, the last facility visit conducted by CDPH and SCCHD was on July 2, 2020.

No deficiencies were observed and cited. A copy of this report was provided to Administrator.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Gladys KuizonTELEPHONE: (408) 834-2558
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2020
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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