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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005513
Report Date: 12/20/2021
Date Signed: 12/20/2021 09:52:01 AM

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:STERLING COURT AT ROSEVILLEFACILITY NUMBER:
317005513
ADMINISTRATOR:MARIANNE RICHARDSONFACILITY TYPE:
740
ADDRESS:100 STERLING CTTELEPHONE:
(916) 786-7200
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:128CENSUS: 68DATE:
12/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Interim Executive Director- Blaine LyonsTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 12/20/2021 to conduct Case Management visit regarding the legal action pending against Sterling Court at Roseville. LPA met with Interim Executive Director (ED), Blaine Lyons, and explained the purpose of the visit. Prior to initiating the Case Management visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and completed a facility risk assessment at the facility. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility.

LPA toured the interior of the facility together with Interim ED to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, two (2) resident bedrooms, (1) bathroom, and kitchen. In the areas toured no immediate health, safety, or personal rights violations were observed. Facility was found to be in substantial compliance at this time.

LPA observed notice posted on the entrance door (conspicuous location) stating administrative action pending. LPA asked to see notice provided to residents, and Interim ED informed that the facility had hand delivered notice to all residents in care. The notice was sent out on 12/17/2021. LPA asked Interim ED if Interim ED notified residents' responsible party, to which Interim ED stated letter was sent out on 12/17/2021. LPA took down Responsible Party's respective phone numbers to verify that they have been notified. LPA notified that if the residents' respective Responsible Parties have not been notified that Civil Penalties could be assessed.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report was emailed to Interim ED who confirmed he received it.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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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