405802259-7-6-2023-29-AS-DCHZ-CTGT6X-20230706142752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405802259
Report Date: 07/06/2023
Date Signed: 07/06/2023 02:28:30 PM

Document Has Been Signed on 07/06/2023 02:28 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	CHATEAU ROSE		FACILITY NUMBER:	405802259
ADMINISTRATOR:	SOO, ARPAD		FACILITY TYPE:	740
ADDRESS:	1555 LAUREL LANE		TELEPHONE:	(805) 439-4774
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	6	CENSUS: 6	DATE:	07/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:13 AM
MET WITH:	Jessica Bailey and Rachelle Tellez, Administrators		TIME COMPLETED:	02:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 7/6/23 at 11:13 am, Licensing Program Analyst (LPA) Chavez made an unannounced Annual/Required visit to the facility listed above. LPA met with Jessica Bailey, Administrator, and Rachelle Tellez, Administrator, and explained the purpose of the visit. A tour of the physical plant was assessed, and the following was noted: LPA observed the license posted, Complaint Poster, Bill of Rights and Right to Residential Council, non-discrimination statement, and resident rights in the front entry and hall near kitchen. The facility has 6 bedrooms and 6 resident bathrooms currently occupying 6 residents. Physical plant was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, all in good condition. The facility maintains a comfortable temperature. The dual smoke and carbon monoxide detectors are hard wired and operational. Fire extinguishers located in the kitchen and the hallway near room #3. The extinguishers were inspected on 05/04/23 and are charged in the green. There are no issues with Fire Clearance. Living room and dining room furniture were checked and in good condition. The common rooms are clean, safe and sanitary. The courtyard of the facility has outdoor furniture with shaded area for residents. There is a jacuzzi on the premises with a hard cover but the locks were not secured. Licensee will ensure the locks are in place at all times to ensure resident safety. Deficiency cited. Continued on 809-C.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CHATEAU ROSE	FACILITY NUMBER: 405802259
	VISIT DATE: 07/06/2023

NARRATIVE

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The kitchen and pantry were sufficiently stocked with two-day perishable and seven-day non-perishables. The menu was posted for review. Foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Refrigerator is kept at 40 F or below and the freezer at 0 F degrees. Resident medications were found in an unlocked drawer in the kitchen. The drawer did not have a lock. Medications were daily dosages for today as the morning medications were empty and the noon, PM, and evening medications were still in the daily containers. Deficiency cited. The kitchen has a cabinet under the sink without a lock containing dish soap and dishwasher soap. Administrator immediately placed a lock on the cabinet during the visit. Technical violation given.
Resident rooms are adequately dressed with sheets, pillowcase, mattress pad, and blankets which are in good condition. There is at least one chair, nightstand and sufficient lighting for each resident. There is enough linen available to change weekly or more, if needed.
Storage cabinets have sufficient amounts of personal hygiene product which is provided by the licensee and all cleaning products, toxins are stored and locked away inaccessible to residents in care.
Bathrooms were checked for cleanliness and proper operation. The hot water temperature measured between 113 F and 114.7 F degrees in resident bathrooms.

All staff have background clearances and are associated to the facility.

The annual inspection needs further investigation. CCL will return at a later date to finalize the annual.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

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