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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577005047
Report Date: 07/28/2021
Date Signed: 07/28/2021 04:21:45 PM

Document Has Been Signed on 07/28/2021 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:BRIDGEWAY CAREFACILITY NUMBER:
577005047
ADMINISTRATOR:RAMON SILVESTREFACILITY TYPE:
740
ADDRESS:2512 MEADOWLARK CIRCLETELEPHONE:
(916) 239-8948
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 6CENSUS: 5DATE:
07/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Ramon Silvestre, LIcensee/AdministratorTIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA ) Jill Nakagawa arrived unannounced to conduct an Annual Required inspection and met with Ramon Silvestre, Licensee. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly.

LPA observed a screening station at the entrance of facility which had hand sanitizer, a thermometer, and a sign-in sheet for visitors. Visitors are screened for COVID-19 symptoms (including temperature check) upon arrival to the facility. Staff and clients' temperatures are taken 2 times a day and is documented. LPA conducted a walk-through of the facility with Licensee and observed COVID-19 precaution postings.
Staff clean and disinfect the facility daily. High touched surface areas are disinfected after each use. The facility has a designated visitation area, provides virtual visits and phone calls for family to stay in contact with residents.

Licensee stated staff are surveillance tested twice a month for COVID-19 as a precaution. LPA observed 5 residents in care. Facility staff have completed training on infection prevention, symptoms, transmission and PPE use. N-95 respirator Fit testing is in process.
LPA observed a supply of PPE including gloves, face shields, N-95 respirators, surgical masks and gowns. All of staff wore a face mask during this visit. The facility has submitted a COVID-19 Mitigation Plan Report on Epidemic Outbreaks specific to COVID-19 to the California Department of Social Services.

Exit interview conducted with Licensee, whose signature on this document confirms receipt.



No deficiencies cited during this inspection
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2021
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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