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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201185
Report Date: 09/20/2022
Date Signed: 09/20/2022 03:26:42 PM

Document Has Been Signed on 09/20/2022 03:26 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:
079201185
ADMINISTRATOR:HERBERT, HELENFACILITY TYPE:
740
ADDRESS:7100 MANILA AVENUETELEPHONE:
(510) 778-9084
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY: 6CENSUS: 5DATE:
09/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Helen Grace Herbert, Licensee and Araceli Emerick, Co-AdministratorTIME COMPLETED:
03:45 PM
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On 09/20/22 at 03:05 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a Pre-Licensing Inspection for a Change of Ownership (CHOW). LPA was greeted by Care Staff upon entry and explained the purpose of the visit. Helen Grace Herbert, Licensee and Araceli Emerick, Co-Administrator (Co-ADM) arrived about 5 minutes later.

LPA discussed the COVID-19 infection control requirements, the importance of attending the informational calls, understanding the updated guidelines and printing the provider information notices (PINS) for residents, authorized representatives and staff so that the facility maintains awareness and updates for compliancy with the Title 22 regulations.

-Component III completed.

Exit interview conducted and a copy of this report provided to Helen Grace Herbert, Licensee and Araceli Emerick, Co-Administrator.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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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