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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201382
Report Date: 11/25/2024
Date Signed: 11/25/2024 11:59:39 AM

Document Has Been Signed on 11/25/2024 11:59 AM - 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:ROSEMONT GARDENSFACILITY NUMBER:
019201382
ADMINISTRATOR/
DIRECTOR:
LEUNG, BELINDAFACILITY TYPE:
740
ADDRESS:1345 CLARKE STREETTELEPHONE:
(510) 483-0150
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY: 45CENSUS: 29DATE:
11/25/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Jeffery Tong, Backup Administrator TIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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Licensing Program Analysts (LPA) J. Clancy-Czuleger and P Manalo, conducted an unannounced visit to the facility for the purpose of a Pre-Licensing evaluation. LPA was greeting by Irene De Leon, Facility Manager. Administrator, Jeffrey Tong Backup Administrator arrived later.

An application was submitted to Community Care Licensing Department (CCLD) for a change of ownership of Residential Care for Elderly 60 years and above. The requested capacity is for (45) Residents, (4) ambulatory and (41) non-ambulatory.

The facility sent updated floor plan to CCLD. There are four bathrooms total in the facility. Two are on the second floor of which one is in a private room, and the other is only accessible to ambulatory residents, and two are on the first floor and only one of which is accessible to non-ambulatory residents. The facility currently has 29 residents, 8 are ambulatory, and 21 are non-ambulatory. This means that there is only one accessible bathroom for 21 non-ambulatory residents.

LPA observed that the kitchen cabinets were greasy and not clean. LPAs also observed that there was not a 7 day non-perishable food supply.

Issues were noted during inspection. LPAs observed that facility is not ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE: DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2024
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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