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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002773
Report Date: 12/28/2022
Date Signed: 12/28/2022 12:24:49 PM


Document Has Been Signed on 12/28/2022 12:24 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ROSELEAF OROVILLEFACILITY NUMBER:
045002773
ADMINISTRATOR:FARMER, AMBERFACILITY TYPE:
740
ADDRESS:1900 20TH STTELEPHONE:
(530) 538-8200
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:60CENSUS: 35DATE:
12/28/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Amber FarmerTIME COMPLETED:
12:30 PM
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LPA Hiratsuka, conducted this unannounced visit to open this complaint. LPA wore a surgical mask during visit and observed all staff wearing one.

Today, LPA conducted a plan of correction visit in response to citations issued on 12/08/2022, as a result of a complaint that was substantiated and delivered on 12/08/2022. Administrator requested an extension for the plan of correction dates because of the holidays and LPA granted the extension.

Administrator wrote a plan of correction to address medication distribution. It meets the regulations. Administrator wrote a plan of correction regarding monitoring residents and had staff trained on urinary tract infections.

The following deficiencies were cleared today:
Title 22 Regulations 87465(a)(4) Incidental Medical and Dental Care.
CA Health and Safety Code 1569.312(e) Basic services requirements.

No deficiencies cited.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2022
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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