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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577000881
Report Date: 12/01/2022
Date Signed: 12/01/2022 02:49:53 PM


Document Has Been Signed on 12/01/2022 02:49 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: 147DATE:
12/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kawana Anthony, Ops. DirectorTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a Case Management Investigation regarding the theft/loss of a resident's (R1) recumbent bicycle. LPA spoke with Kawana Anthony (KA) the Operations Director regarding the theft. During the visit, LPA discovered that another resident (R2) had been the victim of theft/loss of a recumbent bicycle and an adult tricycle. Both residents had been storing their bikes locked on the ground floor of the building. Residents reported the losses to the Davis Police Department and Atria's management team.

LPA spoke with Ops. Director, Kawana Anthony, who said the losses had been reported to the Corporate office.

No deficiencies were found at the time of the investigation. No citations issued.

Exit interview conducted with Kawana Anthony.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022
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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