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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005513
Report Date: 03/07/2022
Date Signed: 03/07/2022 03:48:51 PM


Document Has Been Signed on 03/07/2022 03:48 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
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:
03/07/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Chad Rogers- Executive Director TIME COMPLETED:
03:50 PM
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On 03/07/2022 at 3PM, an Office Meeting was conducted on this day in the Sacramento North Regional Office via Microsoft Teams, due to COVID-19 precautions. The purpose of this Office Meeting was to discuss facility's use of FreeStyle Libre device to monitor blood sugar levels. Present in the meeting was Licensing Program Analyst (LPA) Sarena Keosavang, LPA Talwinder Bains, Licensing Program Manager (LPM) Anthony Perez, LPM Laura Munoz, Regional Manager (RM) Alycia Berryman, Program Nurse Consultant, Cristina Wong, facility's Executive Director (ED) Chad Rogers, and Regional VP of Wellness Genesis Cano.

Topics that were discussed during today's office meeting:
  • Resident's Medical History
  • Staff Training
  • Exception Request
  • Accuracy of Device
  • Medication Interaction
  • Protocol Adjustment
  • Daily Care Plan

ED was advised to submit an exception request to CCL for review.

An exit interview was conducted and a copy of this report will be emailed to Executive Director. Executive Director is to sign the report and email it back to LPA.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2022
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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