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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802285
Report Date: 08/31/2022
Date Signed: 08/31/2022 02:10:41 PM

Document Has Been Signed on 08/31/2022 02:10 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:
08/31/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Diana Barnhill, Licensee/AdministratorTIME COMPLETED:
02:30 PM
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On 8/31/22 at 1:40 pm, Licensing Program Analyst (LPA) Chavez conducted an unannounced Case Management visit to follow-up on a change in the facility’s physical plant. LPA met with Diana Barnhill, Licensee/Administrator, and explained the purpose of the visit.

On 8/6/22, LPA visited the facility for an annual inspection. LPA observed that the facility had a change in layout. LPA observed, and Licensee corroborated, that the formal dining room was being changed into a resident bedroom. The south end doorway of the room had been closed off and a door placed on the north end of the room. On 8/31/22 at 1:42 pm, LPA toured the room and observed that the room has been converted from a formal dining room to a resident bedroom. Currently, the room does not have a closet, dresser, bed, nor chair. LPA informed Licensee that a resident is approved to move in once these items are placed in the bedroom. Prior to move in, Licensee will take a photo(s) of these items in the room and send to LPA. Licensee says the resident is bringing their own chair. LPA observed that the facility has a dining table with seating for six (6) near the aquarium. LPA observed that the room has a smoke detector which is hard wired with the other detectors in the home.

On 8/30/22, Licensee faxed to CCL the Fire Safety Inspection Request (STD 850) showing a fire clearance and a copy of the facility’s updated facility sketch. There is no capacity change. At 2:44 pm, LPA spoke with Battalion Fire Chief Dave Van Son. Chief Van Son confirmed that the converted room has a fire clearance and stated that the room did not need a permit.

Exit interview conducted and the report emailed to the Licensee.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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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