Facility Evaluation Report

Campbell Village, Campbell05/07/2025Licence 435294224

Capacity90
Census66
Date signed05/07/2025 05:07:56 PM
Name of licensing program analystMarcella Tarin
Name of licensing program managerJin Jackie
The inspector’s account

Licensing Program Analysts (LPAs) Marcella Tarin and Manuel Monter conducted an unannounced Case Management to conduct a Non-Compliance Plan Quarterly Visit and met Care Coordinator Gregg Madrigaga. LPAs stated the purpose of the visit. Administrator Geralyn De Ocampo authorized for Gregg Madriaga to sign on her behalf.

The purpose of the visit is to ensure the facility is adhering to the Compliance Plan submitted to Community Care Licensing (CCL) after an informal meeting held on October 22, 2024.

CC tested all 5 delayed egress doors. All 5 delayed egress doors were working properly and free from any obstructions in both memory care and assisted living when tested by CC. LPAs toured the facility inside and out. LPAs did not observe any obstructions in the passageways.

LPAs reviewed staff training such as, but not limited to: Understanding Dementia, completed on March 25, 2025. LPAs also reviewed staff training on Delayed Egress completed on 3/14/2025..

No deficiencies cited per California Code of Regulations, Title 22. An exit interview was conducted with Care Coordinator Gregg Madriaga and a copy of this report was provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction