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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577000881
Report Date: 11/03/2022
Date Signed: 11/03/2022 01:03:11 PM


Document Has Been Signed on 11/03/2022 01:03 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:DANA STANSELFACILITY TYPE:
740
ADDRESS:1111 ALVARADO AVETELEPHONE:
(530) 756-0700
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:210CENSUS: 149DATE:
11/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jake Bruno, Resident Services Director TIME COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a Case Management Visit with Jake Bruno (JB), Resident Services Director on 11/3/2022.

LPA found the facility to be clean, orderly and with no cases of Covid-19. The facility has been diligent in their screening at the entrance, and all staff and visitors are in masks.

LPA and JB went through the reporting guidelines of the facility. LPA informed JB that the reports from Atria Covell Gardens have been timely and well-written, with proper follow-up. LPA also encouraged by the staff's training and re-training regarding medication management. New electronic medication management system at the facility has been on-boarded with staff and seems to be working well.

LPA also followed up on several of the SIR's submitted and current conditions of residents.

There were no deficiencies found at the time of inspection.

No citations issued.

Exit interview conducted with Jake Bruno, Resident Services Director.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022
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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