Senior Care Records.

Facility Evaluation Report

Evergreen Adult Development Center, San Jose10/07/2022Licence 435201385

Capacity216
Census60
Date signed10/07/2022 03:14:55 PM
The inspector’s account

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection focusing on infection control. LPA met with Administrator, Caroline Mayo.

During visit, LPA toured the facility to include the activity rooms, office, bathrooms, kitchen, and exterior. All fire exit routes were free and clear of obstruction.

Facility has a designated central entry point for symptom screening and temperature check for all visitors, clients, and staff. Hand sanitizer made available at entry and throughout the facility. Bathrooms supplied with hand washing sign, paper supplies, and hygiene products. Facility clean and disinfect multiple times daily and as needed. The facility has an isolation room to include a lidded trash can and Personal Protective Equipment (PPE) supplies. LPA reviewed the facility's procedures to isolation and infection control training. The following posters observed to include social distancing, required mask, and symptoms of COVID.

During visit, the following documents were obtained to include facility's change of Administrator and staff's LIC-9182.

No deficiencies were cited per California Code of Regulation, Title 22. Advisory note provided.

This report was reviewed with Administrator, Caroline Mayo and a copy of the report was provided.

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