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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803790
Report Date: 05/10/2022
Date Signed: 05/10/2022 09:53:29 AM


Document Has Been Signed on 05/10/2022 09:53 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:ROSE HAVEN LLCFACILITY NUMBER:
286803790
ADMINISTRATOR:FRANCO, RHONFACILITY TYPE:
740
ADDRESS:520 SANITARIUM RDTELEPHONE:
(707) 963-3748
CITY:ST HELENASTATE: CAZIP CODE:
94574
CAPACITY:32CENSUS: 14DATE:
05/10/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Rhon FrancoTIME COMPLETED:
10:00 AM
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At approximately 08:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a case management Legal/Non-compliance inspection. This visit is to follow up on the office meeting conducted on 04/14/2021, to review areas of non-compliance. LPA were met by Administrator Rhon Franco. There was a small table at the entrance where visitors are screened prior to entry. LPA toured the facility, including food storage areas, medication room, resident rooms and staff areas. A review of staff records showed staff were current with required annual training. There were currently 4 residents receiving Hospice care. The facility was clean and in good repair. Resident rooms and hallways had no discernible odors. Food storage areas on the lower floor were relocated to allow a pest control company to do some work. LPA was informed a monthly contract has been established with a pest control company to reduce the rodent issue. Food items in the kitchen were sealed against pests and to prevent contamination. LPA discussed with Administrator the upcoming infection control procedures and PIN 22-13, and provided a copy.


No citations issued during this visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022
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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