<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150400536
Report Date: 11/03/2021
Date Signed: 11/08/2021 02:44:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ROSEWOOD RETIREMENT COMMUNITYFACILITY NUMBER:
150400536
ADMINISTRATOR:BALABAN, ROCHELLEFACILITY TYPE:
741
ADDRESS:1301 NEW STINE ROADTELEPHONE:
(661) 834-0620
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:220CENSUS: 151DATE:
11/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Executive Director (ED), Rochelle Balaban, Manager of Memory Care Griscel Garcia &
Wellness Coordinator
TIME COMPLETED:
05:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/03/21, Licensing Program Analysts (LPAs) L. Salazar and M. Thao arrived at the facility unannounced to deliver findings on complaint allegations. LPAs were greeted at the front desk where COVID precautionary measures were taken. LPAs stated the purpose of their visit and were allowed entry to the second floor.

During the course of the investigation, LPAs toured the facility, observed medication carts, staff training records and obtained documentation for records review.

Due to computer difficulties, facility was unable to retrieve some of the documentation requested. Based on the records that were reviewed, LPA Salazar provided Technical Violations (TV) for California Code of Regulations (CCR), Title 22, Division 6. See attached 9102 and 9102-C.

LPA reviewed Hospice Care Plans with Staff S1, Staff S2 and Staff 3 and identified areas in the plan that may need to be addressed through training and/or plans of care. Technical Assistance (TA) for the following : Hospice Care; Pressure injuries, Medications Guide, and RCFE self assessment guide and

Exit Interview conducted with facility Executive Director (ED), Manager of Memory Care Unit (S1) and Wellness Coordinator (S3). No deficiencies cited on today's case management inspection.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1