577000881-8-3-2023-21-AS-JNAA-CUCUQ2-20230803154624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 577000881
Report Date: 08/03/2023
Date Signed: 08/03/2023 03:46:36 PM

Document Has Been Signed on 08/03/2023 03:46 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 GARDENS		FACILITY NUMBER:	577000881
ADMINISTRATOR:	BARBARA FLECK		FACILITY TYPE:	740
ADDRESS:	1111 ALVARADO AVE		TELEPHONE:	(530) 756-0700
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY:	210	CENSUS: 143	DATE:	08/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Barbara Fleck, Administrator		TIME COMPLETED:	03:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a 1 year required inspection and met with Administrator Barbara Fleck on 8/3/2023 at approximately 9:00 AM. All visitors are required to register at the front desk upon entry and residents are supposed to sign out at the front desk when leaving the facility. LPA reviewed records and then toured the facility with Administrator. Facility was found to be clean, orderly, and at a comfortable temperature of 74-76 F with all exits free from obstruction. All postings were up and visible as required. Toxins are stored in locked cabinets. There was a supply of hygiene products, cleaners, and paper products for use as needed. 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 has implemented an E-MAR program, utilizing bar codes and computer input for medication administration. 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. An Infection Control Plan was submitted. There is an active Activities Program, with several engagements taking place each day. On the day of inspection there were Bridge and exercise classes, and a Tropical Themed Happy Hour taking place, with plenty of palm trees, leis, and tropical backdrops to set the mood. Continued...

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill Nakagawa	TELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 GARDENS	FACILITY NUMBER: 577000881
	VISIT DATE: 08/03/2023

NARRATIVE

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Ten (10) rooms were inspected for water temperature and cleanliness and maintenance; all were within regulation. Fire clearance is approved for two-hundred and ten (210); one hundred forty-three (143) residents are currently in care at the facility during this inspection.

The fire extinguishers were last inspected on 07/04/2023. The last Emergency Drill was on 07/31/2023 for the PM shift. The Fire Alarm Inspection took place on 05/24/2023. The Fire Sprinkler Inspection was on 05/25/2023.

The kitchen was clean, well-organized and well maintained. Food storage was as per regulation and there were adequate perishable and non-perishable food items as required in Title 22 regulation. Staff were practicing proper hygiene and food-handling. The dining room was clean, and set up with room for residents to navigate around tables and chairs. Plates of food looked attractive and had ample serving sizes. The dining room also offered options if the main course was not to their liking.

No deficiencies during today's inspection.
No citations issued.
Exit interview conducted with the Administrator.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill Nakagawa	TELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC809 (FAS) - (06/04)

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