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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000989
Report Date: 10/11/2023
Date Signed: 10/11/2023 10:45:11 AM

Document Has Been Signed on 10/11/2023 10:45 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:ROSEVILLE ADULT CENTERFACILITY NUMBER:
317000989
ADMINISTRATOR:EVANS, JOHNNAFACILITY TYPE:
775
ADDRESS:531 VERNON STREETTELEPHONE:
(916) 783-5700
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 75CENSUS: 28DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sheldon SchearTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility announced on 10/11/23 to conduct a Required-1 Year Inspection LPA met with the assistant program director (APD) Sheldon Schear and explained the purpose of the visit.

LPA inspected the facility interior. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and APD discussed the infection control practices and facility was found to be in substantial compliance at this time.

LPA reviewed 4 staff files and 5 client files. Files were found to be complete for required information.
LPA advised that R1's IPP and staff training include restricted health condition plan and staff training.

The program is clean, safe and well staffed for the current clients in care.

No deficiencies are being cited as a result of todays inspection.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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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