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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802285
Report Date: 08/06/2022
Date Signed: 08/06/2022 07:19:47 PM

Document Has Been Signed on 08/06/2022 07:19 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ROSE GARDENFACILITY NUMBER:
405802285
ADMINISTRATOR:DIANA BARNHILLFACILITY TYPE:
740
ADDRESS:6100 LOS GATOS ROADTELEPHONE:
(805) 466-2506
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 6CENSUS: 5DATE:
08/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:51 PM
MET WITH:Diana Barnhill, Licensee/AdministratorTIME COMPLETED:
04:45 PM
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On 8/06/22 at 2:51 pm, Licensing Program Analyst (LPA) Chavez conducted an unannounced on-site annual infection control visit to the facility listed above. LPA met with Licensee/Administrator Diana Barnhill, and explained the purpose of the visit.

LPA toured the facility with the licensee and observed the following: The facility has infection control signage at the front door and signage throughout the facility on handwashing, cough etiquette and use of masks. Upon entry to the facility, LPA was screened. Staff are wearing masks. The facility has soap and paper towels in resident bathrooms and in the kitchen. The fire extinguishers (2) are located in the laundry room and kitchen. The extinguishers are fully charged and were inspected on 7/22/22. The exterior gate on the south side of the facility needs a spring or closing mechanism to auto-close the gate. Licensee will install, video the gate closing, and send the video to LPA by 8/13/22. The facility has a change in layout. The formal dining room is being changed into a resident room. The south end doorway of the room has been closed off and a door placed on the north end of the room. Licensee states she is working on getting the facility sketch changed and will get a fire clearance prior to placing a resident. No capacity change.

At 3:24 pm, LPA conducted the Infection Control mitigation module with the supervisor. No deficiencies cited.

Exit interview conducted and report emailed to the licensee.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2022
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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