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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002957
Report Date: 12/13/2022
Date Signed: 01/13/2023 10:15:31 AM

Document Has Been Signed on 01/13/2023 10:15 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:A-PLUS SENIOR CAREFACILITY NUMBER:
315002957
ADMINISTRATOR:BALINT,CARMENUTA(CARMEN)FACILITY TYPE:
740
ADDRESS:6540 ROSE BRIDGE DRIVETELEPHONE:
(916) 572-6970
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 5DATE:
12/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Carmen BalintTIME COMPLETED:
02:00 PM
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 On 12/13/22, Licensing Program Analyst (LPA) Kevin Mknelly pre-licensing inspection for a change of license. LPA followed all Covid precautions. LPA was screened upon arrival.

LPA toured Physical Plant, Food Service, Common Areas, Bedrooms, Bathrooms, Kitchen and Medication Storage. Fire extinguisher is current and First Aid is fully stocked. Kitchen was clean and good repair. Licensee has knowledge of (7) seven (2) two day supply of non-perishable and perishable, and required emergency shelter in place supplies. Rooms inspected have appropriate items and are in good repair. Water temperatures requirements were reviewed. LPA observed centrally stored medications and toxins are to be kept locked and inaccessible to residents. Staff and resident files are to be set up to contain required documents. Covid 19 guidelines and signage discussed and information links provided.

Facility will accept total capacity of six elderly residents. LPA observed this facility appears to be clean, safe, and secured. All common areas appear to be free from hazards, clean and in good repair. As of this date, the Department has received the fire clearance. During this visit, this facility is in substantial compliance and meets the minimum requirements for a RCFE license.

Component III was declined.
Application is pending further review and report provided.

Report was reviewed and report provided.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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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