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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700996
Report Date: 03/02/2022
Date Signed: 03/02/2022 01:26:23 PM

Document Has Been Signed on 03/02/2022 01:26 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:WELLQUEST GRANITE BAY TENANTCO LLCFACILITY NUMBER:
312700996
ADMINISTRATOR:MANOMHEHRI, PARIFACILITY TYPE:
740
ADDRESS:9747 SIERRA COLLEGE BLVDTELEPHONE:
(916) 864-9800
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 135CENSUS: 86DATE:
03/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:LaDonna Hasty- Acting Executive Director TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 03/02/2022 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Acting Executive Director (ED), LaDonna Hasty, and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA completed a facility risk assessment at the facility. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility.

LPA toured the interior and exterior of the facility together with ED to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, two (2) resident bedrooms, two (2) bathrooms, and kitchen. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA, Acting ED, Health & Wellness Director Deziree Thitphaneth completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Sarena Keosavang
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2022
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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