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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005428
Report Date: 08/28/2024
Date Signed: 08/29/2024 07:53:51 AM


Document Has Been Signed on 08/29/2024 07:53 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:ATRIA ROCKLINFACILITY NUMBER:
317005428
ADMINISTRATOR:DANA STANSELFACILITY TYPE:
740
ADDRESS:3201 SANTA FE WAYTELEPHONE:
(916) 435-8800
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:105CENSUS: 91DATE:
08/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Dana Stansel, Executive DirectorTIME COMPLETED:
03:30 PM
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On 8/28/2024 LPA Tryon visited the facility to conduct an annual inspection visit. LPA met with ED Dana Stansel. The facility currently has 91 residents, and approximately 96 staff. The facility consists of assisted living and memory care; and also has independent living apartments (not part of license).

LPA toured the facility including both assisted living building and memory care. Memory care is in a separate building. We toured common areas, dining rooms, kitchen, laundry, medication room, resident apartments, bathrooms/showers, hallways, courtyards, storage areas, and storage for emergency food supplies.

The facility is clean, spacious, nicely decorated, with plenty of space for various activities and outside areas for residents. Apartments are very spacious and nicely decorated. Bathrooms are clean, fixtures in good condition and functional.

Facility has a fire alarm/sprinkler system that is checked/serviced regularly. Fire extinguishers present and charged.

Facility has an infection control plan and is following protocol; has a good supply of PPE.

LPA reviewed 9 of 91 resident files and 9 of 96 staff files. Files include required documents.

LPA interviewed 2 residents and 2 staff.

LPA reviewed the CARE Tool with Executive Director.

At this time, facility appears to be in substantial compliance with regulations, no deficiencies were noted.
Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024
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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