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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002775
Report Date: 02/23/2023
Date Signed: 02/23/2023 01:25:19 PM


Document Has Been Signed on 02/23/2023 01:25 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 GARDENSFACILITY NUMBER:
045002775
ADMINISTRATOR:SMITH, AUDREFACILITY TYPE:
740
ADDRESS:2770 SIERRA LADERATELEPHONE:
(530) 895-0800
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:56CENSUS: DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Lisa Sapp- Interim Executive DirectorTIME COMPLETED:
12:30 PM
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02/23/2023 12:00 PM, Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Lisa Sapp - Interim Executive Director and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask and gloves. Additionally, LPA was screened by facility staff.

LPA and Ms. Sapp toured the facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, hallways, resident bedrooms, storage areas and the courtyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and the Executive Director completed the infection control domain and the facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report was provided to Lisa Sapp- Interim Executive Director.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
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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