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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200708
Report Date: 08/07/2020
Date Signed: 08/07/2020 04:40:44 PM

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:WATERMARK AT ROSEWOOD GARDENS, THEFACILITY NUMBER:
019200708
ADMINISTRATOR:HARRISON, NANCYFACILITY TYPE:
740
ADDRESS:35 FENTON STREETTELEPHONE:
(925) 443-7200
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:115CENSUS: 83DATE:
08/07/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Sanjay Kabadi, Executive DirectorTIME COMPLETED:
04:00 PM
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On 8/7/2020 at 3:30PM, Licensing Program Analyst (LPA) G. Luk conducted a Case Management Tele-visit regarding an incident report via Zoom due to shelter in place order directed by the Governor. LPA spoke to Executive Director, Sanjay Kabadi.

Based on the incident report received on 8/6/2020, resident (R1) was found by a police officer near downtown. Executive Director picked up R1 from the police station and returned to the facility the same day.

Based on interview with Executive Director, R1 will be moving into the memory care unit tonight, 8/7/2020.

Reviewing R1's physician's report dated 10/22/2019 which states that R1 is unable to leave the facility unassisted.

Technical Violation and Technical Assistance was given during this case management.

Exit interview conducted and a copy of this report will be emailed.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace LukTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2020
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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