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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002775
Report Date: 07/31/2021
Date Signed: 07/31/2021 05:32:48 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:
07/31/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Eric Perry (ED)
Administrator Eric Perry		TIME COMPLETED:
06:00 PM
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On July 31,2021 at 12:55 PM, 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 ED Eric Perry and Administrator Darren Trisel.
Capacity: 56, total residents 25. ED reports that 100% of residents have been vaccinated and 18 of 26 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 donned full PPE: hand sanitizer, N95, gloves and drape on entering the building LPA Keane's temp was taken and COVID-19 screening question asked.
LPA Keane met with Executive Director Eric Perry (ED) and Med Tech, Tatum McCall (MT). LPA requested ED post signs in bathroom #430 about hand washing. LPA Keane interviewed 7 out of 25 residents: Are you happy here? Do you get meals regularly? Do you like the food here? If you need assistance with the bathroom, are staff meeting your needs in a timely manner? Are you getting a shower when you need/want one? 5 of 7 residents reported they were happy at the facility, enjoyed the food and overall felt well taken care of. 1 resident stated that she asked for a shower today and had not received on yet. One resident reported dinner was late five minutes one time. LPA Keane informed (ED) who made a call to staff to take resident to the shower. LPA Keane went over 3 random residents files and 602's and no deficiencies in care were noted.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Dawn KeaneTELEPHONE: (530) 895-2660
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2021
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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