Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Rosehaven I. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, of which one may be bedridden. Facility has an approved hospice waiver for 5 residents and the home currently has 3 residents with none on hospice during today's visit. Administrator Jaya Pichika has a current administrator certificate expiring on 09/13/2025.

LPA Lyman along with Caregiver Larry Espinol toured the facility at 10:58 AM. Administrator Jaya Pichika arrived during the visit. LPA toured the physical plant, checked food service, reviewed records and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, one resident restroom, two common restrooms, one staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed two residents with a half bed rails. Resident restrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. At 11:05 AM, LPA observed there are missing drawer pulls in the master restroom. Water temperature measured between 109.4 and 111 degrees F in all facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. The entry door into the garage is secured. LPA observed a locked storage area for cleaning supplies. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. Four out of six smoke detectors are inoperable. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. CONT ON LIC809-C DATED 05/09/2025