Senior Care Records.

Facility Evaluation Report

CCC ARF INC. DBA Nantucket Home 3, San Jose03/23/2022Licence 435201943

Capacity6
Census3
Date signed03/23/2022 01:58:26 PM
The inspector’s account

Licensing Program Analyst (LPA) David Marrufo, Licensing Program Manager Romeo Manzano, and Nurse Lori Kopplinger conducted a tele-visit via Zoom to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility and met with Administrator Maria Valentina Cristobal.

Administrator Cristobal reports that there are currently 0 COVID-19 positive residents and 0 COVID-19 positive staff.

During today's tele-visit, the following recommendations were made to the facility by Nurse Lori Kopplinger:

1. Facility needs to implement a screening log to record visitor and staff symptoms and temperatures.

2. Place hand washing sign in bathroom stating to wash hands for at least 20 seconds.

3. Obtain PPE cart for facility's sole use.

5. Have a 30-day supply of PPEs, including N95 masks.

No deficiencies were cited as per California Code of Regulations, Title 22.

This report was reviewed with with Administrator Cristobal. A copy of the report will be sent to her for it be signed and returned to CCL.

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