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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803790
Report Date: 10/23/2024
Date Signed: 10/23/2024 12:26:38 PM


Document Has Been Signed on 10/23/2024 12:26 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, 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: 0DATE:
10/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Krissia SegoviaTIME COMPLETED:
12:30 PM
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At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a case management visit. This visit is being conducted with Napa County Fire Marshall Erick Hernandez. Licensee was not present at the time of this inspection. The purpose of this visit is to reestablish this facilities fire clearance which was revoked in September 2024, due to Licensee's failure to correct issues with the facilities fire sprinkler system. The issues with the fire system were identified in 2023 and Licensee failed to correct which resulted in the fire clearance being revoked and all residents being relocated.
A fire clearance is not being granted today. Licensee will receive a detailed report from the Fire Marshal on the various items that need to be addressed. Licensee will notify the Fire Marshal and Community Care Licensing when repairs have been completed and a follow up inspection will be scheduled.
During this inspection, LPA observed several areas of the facility with evidence of a rodent infestation. Licensee shall provide documentation of measures taken to address this rodent issue on an ongoing basis.

No citations issued during today's visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024
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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