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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294345
Report Date: 12/03/2021
Date Signed: 12/06/2021 08:57:12 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:WESTMONT OF MORGAN HILLFACILITY NUMBER:
435294345
ADMINISTRATOR:JOLIE HIGGINSFACILITY TYPE:
740
ADDRESS:1160 COCHRANE RDTELEPHONE:
(408) 779-8490
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:112CENSUS: 69DATE:
12/03/2021
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jeeteeh GigliottiTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Christine Dolores conducted a scheduled technical assistance visit and met with Jeeteeh Gigliotti, Resident Service Director (RSD) and Jocelyne Bailon, Compass Rose Resident Service Director (CRRSD).

During visit, LPA conducted a Facetime tour of the inside and outside of the facility with PCC Helen Shi and LPM Jackie Jin. The purpose of the visit was to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility. The RSD reports that there are currently 8 COVID-19 positive residents and 2 COVID-19 positive staff.

During today's tele-visit, the following recommendations were made to the facility by PCC Helen Shi:

1. Place foot operated trash bin with lid outside each isolation room in Assisted Living
2. Remind staff to change their N95 mask after stepping out of each isolation room
3. Limit the staff who goes into the isolation rooms in Assisted Living
4. Memory Care staff to discard PPE (N95s and wipes) inside a plastic bag after exiting each isolation room and then discard plastic bag in designated trash bin
5. Coordinate with staff, management and family in Memory Care to provide additional services for COVID-19 positive resident's prone to wandering

The Department will provide additional PPE supplies.
No deficiencies were cited as per California Code of Regulations, Title 22. This report was reviewed via telephone with Jeeteeh Gigliotti, RSD and an email copy will be provided for signature.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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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