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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577000881
Report Date: 03/28/2023
Date Signed: 03/28/2023 10:18:34 AM


Document Has Been Signed on 03/28/2023 10:18 AM - 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: 135DATE:
03/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Emily Venagas, AdministratorTIME COMPLETED:
10:20 AM
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On March 28, 2023 at approximately 9:00 AM Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced at Atria Covell Gardens, census 135, to conduct a Case Management - Other regarding an inspection visit to review a self-reported SOC 341 suspected abuse report between a resident and family member.

During this visit, LPA Nakagawa met with Administrator Emily Venegas and requested documentation. Report states that mandated reporter heard abusive verbal remarks by Family Member (F1) toward Resident (R1). The incident was brief and there was no physical abuse. The incident was cross-reported to other agencies.

There were no deficiencies observed or cited during this time. Exit interview was conducted with Administrator and a copy of this report was left at the facility
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
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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