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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577000881
Report Date: 07/07/2022
Date Signed: 07/07/2022 02:24:02 PM


Document Has Been Signed on 07/07/2022 02:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:ATRIA COVELL GARDENSFACILITY NUMBER:
577000881
ADMINISTRATOR:EMILY, VENEGASFACILITY TYPE:
740
ADDRESS:1111 ALVARADO AVETELEPHONE:
(530) 756-0700
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:210CENSUS: 149DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Emily Venegas, AdministratorTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a 1 year required inspection and met with Administrator Emily Venegas. The inspection is focused on the Infection Control procedures and practices of this facility.

All visitors, essential visitors, and staff are screened upon entry; temperatures are taken, and screening questions are to be answered before being allowed to remain in the facility, all information is logged. Residents are screened and observed for any changes, all information is logged. Facility was found to be clean, orderly, and at a comfortable temperature of 74 F with all exits free from obstruction. All postings were up and visible as required. Toxins are stored in locked cabinets. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed, as well as an ample supply of PPE and Covid-19 test kits. Medications were stored and locked in the medication room and on the medication carts making them inaccessible to residents and staff that do not handle medications. Facility is implementing a new E-MAR program, utilizing bar codes and computer input for medication administration. Administrator and all staff had a mask on during the LPA's inspection. Facility has an approved dementia plan of operation. There is an approved hospice waiver for nine (9) residents. Mitigation plan was approved by the Department on 07/02/21. Fire clearance is approved for two-hundred and ten (210) non-ambulatory. Fire drills are carried out once a month.
There were one-hundred, forty-nine (149) residents in care at the facility during this inspection.

No deficiencies during today's inspection.
No citations issued.
Exit interview conducted with the Administrator.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022
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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