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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 310303287
Report Date: 03/12/2025
Date Signed: 03/13/2025 10:49:26 AM

Document Has Been Signed on 03/13/2025 10:49 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ROSE GARDEN RESIDENTIAL CARE HOMEFACILITY NUMBER:
310303287
ADMINISTRATOR/
DIRECTOR:		ANDRADA, ROSALINDAFACILITY TYPE:
740
ADDRESS:12520 KILLARNEY WAYTELEPHONE:
(530) 823-8216
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Tito Andrada, Jr and Jerry AndradaTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 3/12/25 LPA visited the facility to do an annual visit. LPA met with Tito Andrada, Jr. and Jerry Andrada.

LPA toured the facility with staff including common areas, kitchen, food storage, bedrooms, bathrooms, storage for potentially hazardous items and substances, yard. Medications are centrally stored and locked.
The facility was clean and in good condition. Food supplies were sufficient to meet the requirement of 2 days perishable and 7 days non-perishable supplies. Food appears to be varied and of good quality. The facility has adequate dishes, pots and pans, etc. Bathrooms are clean and in good condition with plumbing fixtures in good condition. Rooms are appropriately furnished, facility has adequate linens, bedding, towels, etc.
House has a fire alarm system, sprinklers. Carbon monoxide detector installed. Fire extinguisher present and charged, was serviced in October 2024.

Yard is large, shaded, no hazards noted.

LPA reviewed the CARE tool with staff.

LPA interviewed 2 staff and 3 residents.

LPA reviewed 3 staff files and 2 resident files.

At this time, the facility appears to be in substantial compliance with regulations. No deficiencies were cited.

Exit interview conducted.
Troy OrdonezTELEPHONE: (916) 263-4832
Todd TryonTELEPHONE: (916) 263-4700
DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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