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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003994
Report Date: 06/28/2022
Date Signed: 06/28/2022 04:40:52 PM

Document Has Been Signed on 06/28/2022 04:40 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:AEGIS ASSISTED LIVING OF CARMICHAELFACILITY NUMBER:
347003994
ADMINISTRATOR:BILL PHELPSFACILITY TYPE:
740
ADDRESS:4050 WALNUT AVETELEPHONE:
(916) 972-1313
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 90CENSUS: 73DATE:
06/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Bill Phelps, Administrator and Danelle Houle, Business Office ManagerTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced at the facility on 6/28/22 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Interim Executive Director, Bill Phelps and Business Office Manager, Danelle Houle, and explained the purpose of the visit.

Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Mask. Additionally, LPA was screened by facility staff upon entering the facility.

LPA and Business Office Manager toured the interior and exterior of the Assisted Living side of the facility. LPA observed all areas to be clean, in good repair and to be odor free and the bathrooms and kitchen to have paper towels, soap, trash cans with lids and Covd posters.. Facility to ensure hand-washing posters are near all sinks, including in the break room. Facility is limiting staff room to 2 staff at a time. Fire extinguishers observed throughout and to have been last serviced on 3/23/2022. LPA observed multiple Covid posters and hand sanitizers throughout and required postings displayed. Discussed vaccination protocols of residents and staff and visitation protocols in place. A second booster clinic to be scheduled in the upcoming months. LPA and Business office Director completed the Infection Control Domain regarding Covid protocols in place.

LPA requested a copy of LIC308, LIC500 and current liability insurance be emailed to CCLD by 7/5/2022.

There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator.

Exit interview. Copy of report provided to Administrator.


SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
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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