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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200979
Report Date: 08/24/2023
Date Signed: 08/24/2023 12:20:47 PM


Document Has Been Signed on 08/24/2023 12:20 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:ROSEWOOD RESIDENCE LLCFACILITY NUMBER:
079200979
ADMINISTRATOR:EMERICK, ARACELIFACILITY TYPE:
740
ADDRESS:5311 GARVIN AVENUETELEPHONE:
(510) 237-5769
CITY:RICHMONDSTATE: CAZIP CODE:
94805
CAPACITY:6CENSUS: 6DATE:
08/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Araceli Emerick, AdministratorTIME COMPLETED:
12:35 PM
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On 08/24/23 at 08:30 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required annual inspection. LPA was greeted by one staff upon entry and explained the purpose of the visit. The Administrator, Araceli Emerick (ADM) holds a standard certificate (#6047865740) exp. 04/10/24. The facility’s fire clearance was approved for six (6) non-ambulatory residents; two (2) may be bedridden.

Facility has an Infection Control Plan (ICP). LPA observed a screening station at the entry that contained a thermometer, hand sanitizer, masks, face shields, gowns, gloves, COVID-19 signage, and a visitor sign-in log. LPA toured the facility including but not limited to common areas, bathroom, kitchen, garage, and backyard. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. Medication and sharps were locked, and there was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap, paper towels and garbage cans. There is a surplus of PPE centrally stored inside the facility that is accessible to all care staff. Hot water temperature in the shared residents' bathroom was measured at 109.9 degrees Fahrenheit (F) and the facility's temperature was 71 degrees (F). First aid kit complete.

Continued on LIC809C...
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ROSEWOOD RESIDENCE LLC
FACILITY NUMBER: 079200979
VISIT DATE: 08/24/2023
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...continued from LIC809.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was observed full and serviced 04/26/23. Emergency Disaster Plan is updated. Safety drills were last conducted 06/2023 and are rotational between AM and PM schedules monthly.

LPA reviewed five (5) staff records, and all staff have criminal record clearances. Six (6) residents records were reviewed and are complete.

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided to ADM.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC809 (FAS) - (06/04)
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