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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804074
Report Date: 10/03/2024
Date Signed: 10/03/2024 12:00:17 PM

Document Has Been Signed on 10/03/2024 12:00 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ROSE RENEE RESIDENTIAL CARE FACILITYFACILITY NUMBER:
486804074
ADMINISTRATOR/
DIRECTOR:
FRASIER, FELICIAFACILITY TYPE:
735
ADDRESS:1220 SERENO DRTELEPHONE:
(707) 980-6830
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 4CENSUS: 1DATE:
10/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Felicia Frasier (Licensees/Administrators)TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA), Cuadra conducted an unannounced required-1 Year inspection and met with Felicia and Anthony Frasier, Licensees/Administrators. Annual fees are current. Contact information reviewed. Required postings were observed. Client at day program during visit.

LPA/Licensees toured the facility and observed the following: All exits were unobstructed, it was at comfortable temperature, client bedroom is furnished per regulation, sufficient supply of hygiene, cleaning supplies, and paper products for use as needed. fire extinguisher was charged and serviced on April 2024. Water temperature measured 112.8 F degrees which is within regulation. Smoke alarms and carbon monoxide were tested and operational. The facility had a sufficient supply of perishable and nonperishable foods. Toxins and knives were observed inaccessible to client in care. First aid kit complete. Cash resources and records were reviewed. Last disaster drill conducted 7/27/24. Medication and medication records were reviewed.

LPA initiated file review at 11:15am of two(2) staff files and one client records. All staff have required criminal record clearance. All staff have required training and CPR/1st aid certificates. Client files were complete. Administrator certificate for Anthony Frasier #6049162735, expires 7/18/2026.



Licensee provided updated copies of the following: LIC 500 -Personnel Report, LIC 610 - Disaster Plan, LIC 308 - Designation of Responsibility and Copy of Surety Bond.

No deficiencies cited at today's inspection. Exit interview was conducted with Licensee and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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