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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803637
Report Date: 09/26/2023
Date Signed: 09/26/2023 03:47:00 PM

Document Has Been Signed on 09/26/2023 03:47 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ROSEWOOD CRISIS RESIDENTIALFACILITY NUMBER:
486803637
ADMINISTRATOR:NATALIE LEEFACILITY TYPE:
772
ADDRESS:508 ALABAMA STREETTELEPHONE:
(510) 415-4672
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 16CENSUS: 13DATE:
09/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Leesa Durst-Weisman, Program ManagerTIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPA) Carol Fowler arrived unannounced to conduct an Annual Required 1 Year Inspection. This facility operates as a Social Rehabilitation Facility for persons with Mental Disabilities. LPA met with Leesa Durst-Weisman, Program Manager and toured the facility.

Facility Tour: LPA toured the buildings and grounds, the facility was well lit, at comfortable temperature, with all exits free from obstructions. Bedrooms were observed to have the required furniture and linens. Hot water temperature checked between 113.5 degrees F. and within the required regulation of 105 to 120 degrees F. Fire extinguishers present on all floors last serviced 3/15/2023. The facility has a hard wired sprinkler system; smoke and carbon monoxide detectors were available and functional throughout the facility. The last disaster drill was conducted and documented on 9/14/2023 and LPA observed a fire drill during the visit. Perishable and nonperishable food supply was sufficient and met the minimum requirement. Food was observed properly stored, labeled, covered and in good condition. Medications centrally stored and locked in the medicine room. Facility has 3 floors and texts or phone calls are used for communication.

Records review: Facility staff files were reviewed. Staff have current CPR/1st aid. 5 client files were reviewed and found complete. Medication reviewed and found complete, staff provided medication count.

Licensee/Administrator to submit updates of the following documents by: 10/05/2023
Designation of Administrative Responsibility (LIC308)
Personnel Report (LIC500)
Emergency Disaster Plan (LIC610E)
Control of Property

No Deficiencies cited during this visit. A copy of this report provided.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023
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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