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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002775
Report Date: 02/12/2025
Date Signed: 02/12/2025 01:54:51 PM

Document Has Been Signed on 02/12/2025 01:54 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ROSELEAF GARDENSFACILITY NUMBER:
045002775
ADMINISTRATOR/
DIRECTOR:
BINGHAM, DIANIAFACILITY TYPE:
740
ADDRESS:2770 SIERRA LADERATELEPHONE:
(530) 895-0800
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 56CENSUS: 34DATE:
02/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Administrator, Stacey BaxterTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On February 12, 2024 at approximately 01:30 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Roseleaf Gardens for the purpose of conducting a Case Management-Incident Inspection. LPA was greeted at the door by Administrator, Stacey Baxter, and was granted access into the facility.

On January 27, 2025, an SOC 341 and an Incident report was forwarded to Community Care Licensing Division (CCLD) regarding a resident to resident altercation. Administrator reported that there were no severe injuries and that the facility contacted the Primary Care Physician. The primary aggressive resident was reassessed by the Primary Care Physician and changes were made to the medication. As of February 12, 2025, there has been no incidents of aggression.

On February 11, 2025, an incident report was forwarded to Community Care Licensing Division (CCLD) regarding a resident fall. A review of the Incident Report revealed very limited information as to what the outcome of the fall was (See LIC 9102-Technical Advisory). Administrator did report that the resident returned back with no new orders. LPA educated the Administrator on the importance of ensuring that ALL information is accurately transcribed on the LIC 624 as outlined in Title 22 Regulations.

No Deficiencies were cited during today's Case Management-Incident inspection. Exit interview was conducted, and a copy of this report was signed and given to the Administrator.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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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