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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002775
Report Date: 08/01/2021
Date Signed: 08/01/2021 05:22:51 PM

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 GARDENSFACILITY NUMBER:
045002775
ADMINISTRATOR:TRISEL, DARRENFACILITY TYPE:
740
ADDRESS:2770 SIERRA LADERATELEPHONE:
(559) 970-1240
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:56CENSUS: 25DATE:
08/01/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Melody Manville (RCC)TIME COMPLETED:
02:30 PM
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On August 1,2021 at 9:55 AM, Licensing Program Analyst (LPA) Dawn Keane conducted an unannounced site visit/safety check at RCFE, RoseLeaf Gardens located at 2770 Sierra Ladera Chico CA and met with Executive Director Eric Perry (ED) and Resident Care Coordinator Melody Maneville (RCC)
Capacity: 56, total residents 25. (ED) reports that 100% of residents have been vaccinated and 11 of 21 staff are vaccinated.
LPA Keane did a COVID-19 pre screening phone call prior to entering the facility.
Facility reported that no staff nor residents have any COVID-19 symptoms. LPA Keane applied hand sanitizer, N95 mask, gloves upon entering the building LPA Keane's temp was taken and COVID-19 screening question asked.
LPA Keane requested 3 random client's 602, medication schedule and care plan, RCC provided these documents. LPA Keane reviewed documents and requested to see daily log activities for all 3 residents for July 31 and August 1, 2021. based on document review and interviews conducted by LPA Keane it was determined that residents needs are being met at this time
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Dawn KeaneTELEPHONE: (530) 895-2660
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2021
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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