<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700542
Report Date: 03/28/2023
Date Signed: 03/28/2023 12:50:08 PM

Document Has Been Signed on 03/28/2023 12:50 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:SWEET HOME OF ROSEVILLEFACILITY NUMBER:
312700542
ADMINISTRATOR:LOPEZ, DOINAFACILITY TYPE:
740
ADDRESS:6541 LAUREL CREST CIRCLETELEPHONE:
(916) 797-1893
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 5DATE:
03/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Carmen BalintTIME COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/28/2023 at 9:55 am, Licensing Program Analyst (LPA) Ryan Ayers and LPA Kevin Mknelly made an unannounced visit to conduct a required annual inspection at Sweet Home of Roseville. Upon LPAs arrival, caregiver, Lucretia was present at facility and contacted Administrator Carmen Balint, who arrived a 10 minutes later.

There are currently 5 residents who reside at this facility, which is licensed for 6. There are no residents who have restricted health care conditions and no residents who are currently receiving wound care. This facility has a hospice wavier for 4 and currently has 1 residents on Hospice.

LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. Bathrooms and bedrooms were clean and in good repair. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. Smoke alarms were checked and in good working order. Fire drills are conducted as required. LPA observed an adequate amount of linens and found the first aid kit to be complete. Hot water temperature measures at 110 degrees F.

This facility is operating within the scope of their license.
As a result of todays inspection, observations, and interviews, no deficiencies were observed or cited. Record reviews reveal Technical Violation concerning current ANS (LIC 625) for 4 out of 5 residents, and current MA (LIC 602) for 1 out of 5 residents.

Exit interview conducted with Licensee and report copy provided.


SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Ryan Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2023
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 3