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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200661
Report Date: 08/31/2023
Date Signed: 08/31/2023 02:43:06 PM

Document Has Been Signed on 08/31/2023 02:43 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ROSE GARDEN VISTAFACILITY NUMBER:
019200661
ADMINISTRATOR:HASMIN B KOOFACILITY TYPE:
735
ADDRESS:1615 HIGH STREETTELEPHONE:
(510) 533-4929
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY: 15CENSUS: 13DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Haidie Bautista, AdministratorTIME COMPLETED:
01:30 PM
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On 8/31/2023 at 10:45 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Haidie Bautista and explained the purpose of the visit. The facility’s fire clearance was approved for 15 ambulatory clients.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 11 total bedrooms which 8 bedrooms are occupied by the clients and 3 bedrooms are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 70-degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the kitchen sink was measured at 112.2-degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients. There is a minimum of one-week supply of non-perishables and 2-day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 12/5/22. First aid kit was observed to be complete. Fire drill was last conducted on 04/05/23.

At 11:40 a.m., 5 of 5 clients’ records were reviewed and were complete. At 12:35 p.m., 5 staff records were reviewed, and 5 of 5 have current first aid training and areassociated to the facility. A sample of 3 client’s medications were reviewed.


No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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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