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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577000881
Report Date: 07/16/2024
Date Signed: 07/16/2024 04:21:35 PM


Document Has Been Signed on 07/16/2024 04:21 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:BARBARA FLECKFACILITY TYPE:
740
ADDRESS:1111 ALVARADO AVETELEPHONE:
(530) 756-0700
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:210CENSUS: 156DATE:
07/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Barbara Fleck, AdministratorTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a 1 year required inspection and met with Administrator Barbara Fleck LPA met with Administrator, Barbara Fleck and the Resident Services Director, Susan Alexander on 07/16/2024 at approximately 1:40 PM. Facility has an approved dementia plan of operation. There is an approved hospice waiver for nine (9) residents. The facility has 156 residents in Assisted Living and Memory Care.

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 five resident files and five employee files and found them to be complete, including updated Needs and Services Plans.

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 only medication technicians are allowed to handle medications. Facility uses an E-MAR program, utilizing bar codes and computer input for medication administration. There is an active Activities Program, with several engagements taking place each day.

LPA will continue Annual Inspection of facility at a later date.

No deficiencies were found at the time of inspection. No citations issued.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2024
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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