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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700019
Report Date: 01/21/2025
Date Signed: 01/21/2025 01:44:00 PM

Document Has Been Signed on 01/21/2025 01:44 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:TERRACES OF ROSEVILLE, THEFACILITY NUMBER:
312700019
ADMINISTRATOR/
DIRECTOR:		CLAWSON, KRISTINEFACILITY TYPE:
740
ADDRESS:707 SUNRISE AVETELEPHONE:
(916) 786-3277
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 199TOTAL ENROLLED CHILDREN: 0CENSUS: 143DATE:
01/21/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Kristine Clawson, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Executive Director (ED) Kristine Clawson to conduct a case management visit to follow-up regarding a potential fire on cite.

Interview with ED indicated that there was no fire on the premises. ED stated that, on 1/15/2025, resident (R1) had placed a remote control in a microwave and smoke from the microwave triggered the smoke alarms. ED stated that staff had evacuated R1 from their apartment and unplugged the microwave. Staff contacted the fire department, who did not identify a fire on the premises. ED stated that R1 is receiving 1:on:1 care and is being observed. ED stated that R1 also received a medication change to address change in condition.

During visit, LPA observed R1's apartment and did not observe any damage in apartment.

As a result of today's visit, no deficiencies are being cited. Exit interview was conducted with ED. Signature on these forms acknowledges receipt of these documents.
Anthony PerezTELEPHONE: (323) 485-4915
Michael HoodTELEPHONE: (916) 531-7341
DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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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