435294340-9-25-2024-26-AS-KJAN-D9FTQ8-20240925145532

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435294340
Report Date: 09/25/2024
Date Signed: 09/25/2024 02:55:47 PM

Document Has Been Signed on 09/25/2024 02:55 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:	MOLDAW FAMILY RESIDENCES AT 899 CHARLESTON		FACILITY NUMBER:	435294340
ADMINISTRATOR:	ELYSE GERSON		FACILITY TYPE:	741
ADDRESS:	899 EAST CHARLESTON ROAD		TELEPHONE:	(650) 433-3600
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94303
CAPACITY:	270	CENSUS: 207	DATE:	09/25/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Layana Santos and Mark Baddas		TIME COMPLETED:	03:15 PM

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On September 25, 2024, Licensing Program Analysts (LPAs) Kiran Jain and Komal Charitra arrived at the facility at 09:15 AM to conduct the Annual 1-year required inspection. LPAs met with Layana Santos, Director of Health Services and explained the purpose of the visit. Mark Baddas, Executive Director joined shortly after.

This is a multi-building, multi-floor 193-unit facility, with a combination of memory care (9 residents), assisted living (14 residents), and independent living (184 residents). LPAs toured the physical plant and observed it as clean, orderly, in good repair, well furnished, and at a comfortable temperature. Assisted living units are one or two bedrooms with private bathrooms. The memory care unit has its own common areas, secure courtyard, and activity rooms. The facility has outdoor spaces, dining rooms, and recreational rooms such as activity rooms, fitness centers, and wellness spaces. The residents have access to the Oshman Family Jewish Community Center for pools, cultural events, and other activities.

All common areas were observed to be free from obstructions, and hallways were well-lit. The fire extinguishers were fully charged and last serviced on February, 2024. Emergency exit routes were clear and evacuation plans were posted at multiple locations throughout the facility. The facility’s emergency disaster plan was reviewed. No accessible bodies of water or hazards were observed. LPAs observed that the facility was equipped with keypad access security features. Auditory alarm on exit doors in memory care unit were observed to be operational. The smoke detector and carbon monoxide detector were fully operational.

LPAs inspected resident’s rooms and bathrooms at random in the Memory care and Independent Living units. Rooms were observed to be clean with the required furniture and sufficient lighting. The hot water temperature was measured in the residents’ units between 113.6°F and 117.2°F. Sharp objects, detergents, poisons, and chemicals were observed to be locked and inaccessible to persons in care. The residents were seen actively engaged in recreational programs and activities.

SUPERVISOR'S NAME: April Cowan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Kiran Jain	TELEPHONE: (650) 416-4836
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: MOLDAW FAMILY RESIDENCES AT 899 CHARLESTON	FACILITY NUMBER: 435294340
	VISIT DATE: 09/25/2024

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LPAs observed the dining room and the main kitchen. The kitchen was observed to be clean and well-organized and had the required 7 days of non-perishables and 2 days of perishables. LPAs toured three walk-in refrigerators, 1 freezer, and 1 pantry for the dry food. Food items was wrapped, dated and no expired food items were observed.

LPAs reviewed five resident records and six staff records. All were observed to be complete. The resident’s medications are securely stored in a locked room. Medication administration records (MARs) were reviewed and found to be complete, and no expired medications were observed. The First Aid kit was checked and observed to be complete. Emergency drills are conducted monthly with the last drill documented on 08/30/2024.

The following updated forms are requested to be submitted to CCLD by 10/02/2024:

· LIC 500: Personnel Report
· LIC 308: Designation of Facility Responsibility
· Administrator Certificate(s)
· Liability Insurance

No deficiencies were cited during today's visit.

An exit interview was conducted. This report was reviewed with Mark Baddas, Executive Director, and Layana Santos, Director of Health Services, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: April Cowan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Kiran Jain	TELEPHONE: (650) 416-4836
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC809 (FAS) - (06/04)

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