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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700888
Report Date: 04/08/2022
Date Signed: 04/08/2022 11:23:55 AM


Document Has Been Signed on 04/08/2022 11:23 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:RNCARE HOUSE @ EAST ROSEVILLEFACILITY NUMBER:
312700888
ADMINISTRATOR:ESTANTE, EDWARDFACILITY TYPE:
740
ADDRESS:484 CALDARELLA CIRCLETELEPHONE:
(916) 200-8067
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 5DATE:
04/08/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Haxel EstanteTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 4/8/22 to conduct a Annual Inspection and Poste licensing inspection utilizing the infection control domain guidance. LPA met with Hazel Estante and explained the purpose of the visit. Prior to initiating the inspection, LPA completed required COVID-19 safety protocols. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by Hazel upon entering the facility.

Facilitty has had residents for approximately 2 weeks.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Hazel covered the infection control topics and facility was found to be in substantial compliance at this time. Facility is currently using HCA staffing at times.

LPA advised: maintaining record of staff vaccination status and weekly testing of those not fully vaccinated to be maintained at the facility, double check on guardian that staff fingerprinted are associated to the facility (including agency staff who work independently with residents), Visitation sign be posted outside the front door, barrel was moved to allow unobstructed exit from side yard, insulin was secured while LPA present, develop a system that allows staff administering medication to know the medication and dose dispensed, secure cleaning supplies in the laundry room.


No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2022
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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