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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700326
Report Date: 08/22/2024
Date Signed: 08/23/2024 08:20:21 AM


Document Has Been Signed on 08/23/2024 08:20 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:ROSEBERRY CAREFACILITY NUMBER:
342700326
ADMINISTRATOR:QUISTGUARD, JESSICAFACILITY TYPE:
740
ADDRESS:128 BERRY STREETTELEPHONE:
(916) 780-3369
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:15CENSUS: 13DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jessica QuistgardTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 8/22/24 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with Administrator and explained the purpose of the visit. Administrator accompanied LPA with the inspection.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. The home is very clean and residents stated they are happy with care.

LPA reviewed 5 resident files. Files are complete and well organized. During the inspection LPA spoke briefly with three residents who expressed satisfaction with care and staff interactions.

LPA reviewed 2 staff files. Files are complete.

LPA and Administrator discussed several issues.

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


Exit interview conducted with licensee and copy of report left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
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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