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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005900
Report Date: 12/30/2024
Date Signed: 12/30/2024 11:17:35 AM

Document Has Been Signed on 12/30/2024 11:17 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:MEADOW OAKS OF ROSEVILLEFACILITY NUMBER:
317005900
ADMINISTRATOR/
DIRECTOR:		JESSICA SANDERSFACILITY TYPE:
740
ADDRESS:930 OAK RIDGE RDTELEPHONE:
(916) 774-0200
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 108TOTAL ENROLLED CHILDREN: 0CENSUS: 73DATE:
12/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Jessica SandersTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 12/30/24, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit and met with Executive Director, Jessica Sanders.

On 12/27/24, the department received a Death Notification for R1's passing on 12/20/24 unexpectedly. The notification stated that R1 was found by caregiver at 7:50 AM, unresponsive and seated in a recliner in their room. R1's death was not expected and R1 was not on hospice care.

LPA requested and reviewed R1 records prior to this visit. LPA received additional records during this visit. LPA also conducted interviews of caregiver who found R1 on 12/20/24, Executive Director and had spoken with family prior to this visit.

R1 was least seen by med tech (S2) at 6:30 AM, on 12/20/24. R1 did not appear to be in distress. At 6:30 R1 refused a medication.

From records review and interviews, R1 appears to have had a natural death. R1 had a number of co-morbidities. Coroner's report is pending.

As a result of today’s inspection, no deficiencies were noted at this time.

Report reviewed. Copy of report provided.
Maribeth SentyTELEPHONE: (916) 263-4813
Kevin MknellyTELEPHONE: (209) 814-1925
DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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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