150400536-4-25-2023-24-AS-DWIS-CR8T2J-20230425142049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 150400536
Report Date: 04/19/2023
Date Signed: 04/25/2023 02:21:13 PM

Document Has Been Signed on 04/25/2023 02:21 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	ROSEWOOD RETIREMENT COMMUNITY		FACILITY NUMBER:	150400536
ADMINISTRATOR:	BALABAN, ROCHELLE		FACILITY TYPE:	741
ADDRESS:	1301 NEW STINE ROAD		TELEPHONE:	(661) 834-0620
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93309
CAPACITY:	220	CENSUS: 142	DATE:	04/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:34 AM
MET WITH:	Director of Assisted Living, Cille Caldwell Administrator, Rochelle Balaban		TIME COMPLETED:	04:10 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	Licensing Program Analyst (LPA) Darius Williams conducted an unannounced Annual Inspection visit. LPA Williams met with Director of Assisted Living, Cille Caldwell and Administrator, Rochelle Balaban. LPA Williams discussed the purpose of the visit. LPA Williams toured the facility with the Administrator and Director. The 1st and 4th through 9th floor are independent living. The 2nd and 3rd floor house the Assisted Living and Memory Care unit. The tour began on the 9th floor and ended on the 1st floor. All floor landings had emergency chairs in the stair wells. All independent living areas were clean and in good repair. The assisted living floors were clean and in good repair. LPA Williams observed four residents eating in the dining room on the third floor. All meals are prepared and catered from the first floor kitchen. Residents have their own bedrooms with an attached bathroom. Bathrooms were equipped with a non-slip mat and grab bars. The medication room and carts were observed locked on the second floor. The second floor also houses the Memory Care unit. Residents have their own bedrooms and bathroom. A extra shower is available for residents who require extra assistance; bathroom was equipped with grab bars and non-slip mat. Residents were sitting in the dining room eating. Continued in LIC-809C

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ROSEWOOD RETIREMENT COMMUNITY	FACILITY NUMBER: 150400536
	VISIT DATE: 04/19/2023

NARRATIVE

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There is a large dining hall available on the first floor. Attached to the dining hall was the main kitchen where food is prepared. There was two days of perishable food and one week of non-perishable food. Refrigerators reflected approximately 36 degrees Fahrenheit (F) and Freezer reflected approximately -6 degrees F.

There is a pool and two activities buildings adjoining the facility. The pool was clean, free of obstruction, and locked.

Smoke detectors, carbon monoxide, and fire extinguishers were present and operational.

LPA Williams reviewed nine employee files, via hard copy files and electronic record keeping system Relias, and ten resident files via their electronic record keeping system Unity. Nine of nine employee files had required annual training and criminal record clearances. 10 of 10 resident files had required documents.

LPA Williams requested the following documents be provided to the department by 4/26/2023; LIC 500 Personnel Report, LIC 308 Designation of Facility Responsibility, Liability Insurance, and Administrator Certificate.

No deficiencies were cited at this time.

An exit interview was conducted and a copy of this report will be provided via e-mail.

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC809 (FAS) - (06/04)

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