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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577000881
Report Date: 10/07/2020
Date Signed: 10/08/2020 08:34:05 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ATRIA COVELL GARDENSFACILITY NUMBER:
577000881
ADMINISTRATOR:ASHLEE SLOANFACILITY TYPE:
740
ADDRESS:1111 ALVARADO AVETELEPHONE:
(530) 756-0700
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:210CENSUS: DATE:
10/07/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:Ashlee SloanTIME COMPLETED:
04:45 PM
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On 10/7/2020 Licensing Program Analyst (LPA) Walters met with Executive Director, Ashlee Sloan (AS) via teleconference in order to conduct a Case Management inspection regarding two self reported incidents of suspected theft at the facility. A tele-visit was conducted due to COVID-19 precautions. The reader is advised that this visit did not take place in person.

On 10/5/2020 it was reported to Community Care Licensing (CCL) that a resident, (R1's) jewelry was missing from their private residence. On 10/2/2020 CCL received another report that resident (R2's) jewelry was missing from their private residence, the total worth of jewelry being $5,700. The Administrator notified Law Enforcement, CCL and the Ombudsman to report the theft. An investigation is being conducted by the Davis Police Department. On 10/5/2020, AS reported to CCL that resident's R1 and R2's jewelry were found.

LPA reviewed records, LPA also performed interviews with R1, R2 and Administrator.
During the course of this visit, LPA also discussed regulation 87208(9), Plan of Operation with Ashlee Sloan. LPA is requesting a copy of Residential Care Theft and Loss Policy, resident records and policy on safeguarding.

No deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020
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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