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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803807
Report Date: 06/18/2020
Date Signed: 06/18/2020 12:29:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ROHNERT PARK RTRMT COM-HAPPY LVNG BY COGIR/COGIRFACILITY NUMBER:
496803807
ADMINISTRATOR:MARTINO, AMANDAFACILITY TYPE:
740
ADDRESS:4855 SNYDER LANETELEPHONE:
(707) 585-7878
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:45CENSUS: DATE:
06/18/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Amanda Martino-AdministratorTIME COMPLETED:
11:30 AM
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LPA contacted Administrator Amanda Martino to conduct a case management tele-visit. LPA is conducting this televisit, on 6/18/20 at approximately 10:55AM. The reader is advised that the LPA did not physically make a site visit due to Covid 19 status.

LPA conducted this inspection to investigate Covid 19 pandemic policies in place, PPE supply and visitation policies. LPA discussed with Administrator facility's Covid 19 pandemic policies in place currently at the facility today 6/18, also on 6/9, and 5/12. The Covid 19 precautions in place are for the health and safety of all residents in care.

Investigation revealed that staff working are wearing masks, and gloves, washing hands with soap and water, using sanitizer as needed. Facility is ensuring to disinfect items and areas daily and/as needed. Staff have temperatures taken and answer questions before they can work; If staff have a fever or are sick they are sent home. They must see there Physicians and obtain certain information and Dr's note before they can return to work. Administrator stated her PPE supply is sufficient, and there have been no positive cases of residents of the RCFE and/or staff. Administrator stated that visitation options available to residents are video calls, telephone calls, and the window visiting; There is an intercom so visitors and the resident can communicate verbally while seeing each other through the window. Administrator stated that she will ensure that she in-services a training with all staff regarding reminders of the current pandemic policies in place, visitation policies for residents in care, including hospice residents. Administrator stated that she is working with residents and families as needed to address questions regarding pandemic policies, residents current status, and the visitation policies to ensure understanding by all parties, and for the facility to ensure the health and safety of all residents in care. Administrator does this review of pandemic policies monthly with all residents. Administrator stated that the facility is ensuring contact with residents, Physician, and responsible party(s) regarding residents in care and current health status as needed due to the Covid 19 pandemic that is happening,.and being experienced by the residents. Administrator stated that she will continue to remind all staff, supervisors, and residents as needed, of all facility's current pandemic policies in place.
No citations cited today.
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina AlvisoTELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2020
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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