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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005428
Report Date: 09/26/2022
Date Signed: 09/26/2022 02:13:44 PM


Document Has Been Signed on 09/26/2022 02:13 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ATRIA ROCKLINFACILITY NUMBER:
317005428
ADMINISTRATOR:DANA STANSELFACILITY TYPE:
740
ADDRESS:3201 SANTA FE WAYTELEPHONE:
(916) 435-8800
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:105CENSUS: 89DATE:
09/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Dana StanselTIME COMPLETED:
02:30 PM
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On 9/26/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a Required 1-Year inspection. LPA met with Executive Director, Dana Stansel, and explained the purpose of the visit. Prior to today's inspection, LPA completed required COVID-19 testing protocols and completed daily assessment and confirmed the facility does not currently have any positive COVID-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical mask.

LPA and Executive Director toured the interior of the assisted living unit to ensure health and safety of residents in care. Areas toured included but not limited to: activity room, resident services room, kitchen, laundry room, restrooms and common areas. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA observed (2) residents to be sitting outdoor in the shaded area. LPA observed (10) residents to be participating in yoga exercises in the activity room. LPA observed staff to be in compliance with mask. LPA observed the facility to have the mandatory postage in the hallway. LPA observed the Administrator Certificate #6044716740 to be up to date. LPA observed the kitchen to have 2+ days of perishable and 7+ days of non-perishable. LPA observed the facility to have ample supply of PPE. LPA observed medications and toxics to be locked and secured. LPA and Executive Director completed the infection control domain and facility was found to be in compliance at this time. LPA obtained a copy of the LIC 308, LIC 500, current liability insurance and Administrator Certificate.

No deficiencies are being cited as a result of today's inspection.

Exit interview conducted and copy of report left at the facility..
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2022
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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