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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002773
Report Date: 07/18/2022
Date Signed: 07/18/2022 03:35:13 PM


Document Has Been Signed on 07/18/2022 03:35 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ROSELEAF OROVILLEFACILITY NUMBER:
045002773
ADMINISTRATOR:BROWN, TERRY LFACILITY TYPE:
740
ADDRESS:1900 20TH STTELEPHONE:
(530) 538-8200
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:60CENSUS: 34DATE:
07/18/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Amber Farmer, RCCTIME COMPLETED:
03:50 PM
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On 7/18/2022, Licensing Program Analyst (LPA) Jaclyn Avila met with Resident Care Coordinator (RCC) Amber Farmer for an unannounced case management visit. The facility currently does not have an administrator. Regulations for administrator qualifications and duties were discussed with RCC. Letter was also provided to RCC regarding which documents were required to change the administrator.

LPA toured the facility and found that the temperature was cooler than Friday 7/14/2022. LPA observed the air conditioner vendor at the facility who advised he would be providing an invoice today and could have the air conditioner fixed by Wednesday 7/20/2022 latest. Until then, facility has portable AC units installed to assist in cooling the building.

Vendor for the fire alarm visited the facility on todays date (7/18/2022) and met with CALFIRE Deputy Fire Marshal. It is the recommendation from subject matter expert and Deputy Fire Marshal that the fire alarm system be replaced immediately due to the system being antiquated. Vendor will provide a 2nd invoice to the facility by close of business today. The first invoice recommending a new system due to the original system malfunctioning, was provided June 17th, 2022 to the licensees Chief Operating Officer via e-mail.

At time of LPAs visit, two plumbers were currently working on the waterheater to determine why the unit is not outputting cold water. At the time of this report, water temperature can not be controlled by staff or residents in the upper hall. RCC will update LPA with timeline of having the unit fixed.

LPA discussed increasing staffing on NOC shift. RCC agreed and will have an additional caregiver. Facility will provide daily schedule to LPA via e-mail.

No citations issued on today's date. Exit interview conducted
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2022
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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