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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700803
Report Date: 10/06/2020
Date Signed: 10/07/2020 08:54:30 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ROSE PLACE MEMORY CAREFACILITY NUMBER:
392700803
ADMINISTRATOR:KNOLL, LORIFACILITY TYPE:
740
ADDRESS:1119 ROSEMARIE LANETELEPHONE:
(209) 307-6696
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:68CENSUS: 37DATE:
10/06/2020
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:William Lasky and Betty Dominici TIME COMPLETED:
05:00 PM
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On 10/06/2020 at 4:30pm, CCLD Sacramento South conducted a conference call with the Licensees. Present for the call was Regional Manager (RM) Krystall Moore, Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Diego Escobar, Centralized Applications Bureau (CAB) Hao Nguyen, Licensees Willian Lasky from Living Care Centers LLC and Betty Dominici from A&A Senior Living Management LLC. Kamal Grewal, A&A COO, and Raj Thandi, A&A Regional Clinical Director, were also on the call.

Betty discussed concerns regarding A&A's involvement with Rose Place Memory Care. Betty would like A&A to be removed form the Rose Place Memory Care license. Rose Place Memory Care was issued a provisional license on 4/9/2020 with an expiration date of 10/9/2020. As of today, 10/6/2020, Rose Place Memory Care has met the requirements to be issued a regular license. Betty will be meeting again with William to discuss A&A's removal from the license. William agreed to submit documentation to CCLD to reflect the change.

Exit interviewed conducted and copy of report submitted via email. Licensee is to sign and send back to LPA.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) -26-4752
LICENSING EVALUATOR NAME: Diego EscobarTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2020
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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