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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202597
Report Date: 06/02/2020
Date Signed: 06/03/2020 11:50:05 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:WESTWIND MEMORY CAREFACILITY NUMBER:
445202597
ADMINISTRATOR:KAREN TRAVISFACILITY TYPE:
740
ADDRESS:160 JEWELL STREETTELEPHONE:
(831) 421-9100
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:59CENSUS: 45DATE:
06/02/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Karen TravisTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) James Santos conducted an unannounced tele-visit case management today. Due to the current COVID-19 situation, LPA met with Executive Director Karen Travis via facetime.

The purpose of the case management was to follow up on some changes on the first floor level of the facility where an isolation area was designated. A wall of plastic materials were erected around the 5 rooms which has created a small area which would allow residents to isolate in the entire area in the event an outbreak of COVID-19 occurs in the facility.

Per interview with the ED, the isolation area is also designed in the event a resident needs to be isolated due to a potential exposure from a hospital or doctor visit, a resident can return to this area into one of the furnished apartments for a short stay while isolating and then return to their own apartment. This allows the resident to not have to be isolated in their rooms with the door closed. The area is also designed for those residents who have a tendency to have trouble sitting still or who prefer to walk or have wandering behaviors. The design of the isolation area would allow for a safe environment. Also in the event that new residents are admitted in the facility, they would move directly into the isolation area for quarantine to ensure they have not been exposed and then move into their respective apartments.

ED stated that staff can access the isolation area with proper PPEs. Activities can be provided to the residents in the isolation area. Staff are also monitoring the isolation area inside and outside to ensure safety of the residents. A picture of the facility sketch with the isolation area was provided to CCL.

No deficiencies cited. A copy of this report was emailed on 6/2/2020 to the Executive Director for signature.
SUPERVISOR'S NAME: George NwaforTELEPHONE: (650) 269-7419
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2020
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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