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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294345
Report Date: 03/15/2021
Date Signed: 03/15/2021 02:46:49 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:WESTMONT OF MORGAN HILLFACILITY NUMBER:
435294345
ADMINISTRATOR:STEVEN SILACCIFACILITY TYPE:
740
ADDRESS:1160 COCHRANE RDTELEPHONE:
(408) 779-8490
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:112CENSUS: 78DATE:
03/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Patrick FrazierTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Karen Taku and Health Facility Evaluator Nurse Marylene Majeska, conducted a virtual tele-visit via ZOOM, to provide technical assistance to prevent and mitigate the spread of COVID-19 within the facility. LPA met with interim Executive Director (ED) Patrick Frazier.

During today's tele-visit the following recommendations were made to the facility:

1. Reach out to the local county health department, for assistance and recommendations regarding incomplete vaccinations.

2. Contact occupational medicine clinics (eg. Concentra) or industrial hygienist that offers Fit Testing.

This report was reviewed with the ED and a copy was provided via email for signature.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Karen TakuTELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021
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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