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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202557
Report Date: 11/08/2022
Date Signed: 11/08/2022 01:14:37 PM


Document Has Been Signed on 11/08/2022 01:14 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:BED OF ROSES RESIDENTIAL CARE HOMEFACILITY NUMBER:
435202557
ADMINISTRATOR:WILLIAMS, MARIA CHRISTINAFACILITY TYPE:
740
ADDRESS:1730 WHITE OAKS ROADTELEPHONE:
(408) 603-7598
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:6CENSUS: 4DATE:
11/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:11 PM
MET WITH:Maria Christina WilliamsTIME COMPLETED:
01:17 PM
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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 11/08/2022 at 12:10pm. LPA met with Administrator Maria Christina Williams (Admin).

LPA toured the facility, including living room, kitchen, dining room, 5 client bedrooms, 1 staff bedroom, 2 bathrooms, front patio, back yard, and storage sheds. All staff members observed to be wearing masks. Admin confirmed that all staff and residents have been vaccinated.

Facility Infectious Control plan has already been submitted. No prohibited items noted in resident rooms. All emergency exits noted to be clear of obstruction. All rooms in facility noted to be clean and well maintained. Hand sanitizers, soap, and paper supplies were observed to be available. At least 2 days' supply of perishable food and at least 1 week's supply of non-perishable food was observed on the premises. Fire extinguishers observed to be inspected in August of 2022.

Facility observed to have designated entry point. Staff took LPA's temperature and screened for symptoms. Facility has a 30 day supply of N95s and gowns. Restrooms observed to be stocked with paper towels and soap. Hand washing signs observed to be in all bathrooms. Social distancing signs observed to be posted public areas. Facility temperature observed to be 69*F. Facility water temperature observed to be 108.3*F.

No deficiencies cited during today's visit. This report was reviewed with Administrator Maria Christina Williams (Admin) and a copy of the signed report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
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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