Non-compliance follow-up·January 21, 2026

Licensing Program Analysts (LPAs) Julie Florio and Marisol Cuadra arrived at this facility unannounced to conduct a Case Management Legal/Non-Compliance visit and was greeted by staff. Jean Felix, Licensee arrived later. LPAs were following up on items that were concerning and ensure compliance with Non-Compliance Conference dated 11/19/25: HSC 1569.605 - Liability On and after July 1, 2015, all residential care facilities for the elderly - Facility failed to have a current liability insurance with required amounts. The Licensee agrees to provide a copy of the facility current liability insurance. CCR 87213 - Finances - The licensee shall have a financial plan that conforms to the requirements of Section 87155 by not later than April 15, 2026. The Department requires Licensee to submit quarterly financial statements including January, February and March 2026 operational costs of the facility, which includes the following: 1. Profit & Loss statements for the months identified above or in the report. 2. Rent, payroll, income & expense third party documents such as utility statements (gas, electric, etc) supporting the amounts entered on the LIC401 3. Balance sheet for January, February and March 2026, and supporting third party documents, such as liabilities (loans, credit cards) supporting the amounts entered on LIC403 4. All Bank statements used for the operation of the facility for the months identified, cash reserve documents for the facility's emergency needs. Continued on LIC809C... Continued from LIC809... 5. Current General Liability Insurance and Workers Compensation Insurance. 6. Any financial records deemed relevant to support the licensee has an adequate financial plan, as required by law, such as Form 941, the Employer's Quarterly Federal Tax Return, & Quarterly Contribution Return and Report of Wage - DE 9. Previously an office meeting was conducted on 11/19/2025 in the Santa Rosa Regional Office, where other deficiencies were discussed including Fire Clearance. During today's visit, LPAs toured the facility and observed the dining room was converted to a resident's room. Resident (R1) is occupying dining room, which is not cleared by the Fire Department as a resident room. The facility fire clearance dated 5/5/2020 allows for two ambulatory, two non-ambulatory and two bedridden residents. LPAs reminded the Licensee that they were not allowed to have residents in the dining room due to the room was not cleared by the fire department as a resident's room. Licensee agreed to submit STD850 form requesting an updated fire clearance along with an updated facility sketch indicating the use of dining room as a resident room for the Fire Marshall to assess bedrooms to grant or deny fire clearance. Licensee is operating outside the limitation of the license by accepting a resident in a non-cleared room. As a result of the fire clearance violation, an immediate civil penalty in the amount of $500 is issued today. LPAs confirmed that the residents were safe and secure and that there was proper amounts of food stores, power, water and heat. Facility was a comfortable temperature and had power, water, and heat. Food stores were sufficient to sustain residents in care for seven (7) days as required per regulation. At approximately 11:58am, LPAs observed screen in sliding door located in exit door #3 in shared room #4 as well as door bottom strip needs to be repaired/replaced. Also, one out of two garbage cans located in shared room #4 was observed uncovered with no lids, and containing dirty depends. LPAs will issue a technical violation for Maintenance & Operation and have a conversation with the Licensee regarding regulation indicating: "The facility shall be clean, safe, sanitary and in good repair at all times". Continued on LIC809C... Continued from LIC809C... Additionally, LPAs observed three residents (R1, R2 & R3) are currently receiving hospice services without obtaining an exception or hospice waiver increase approval from the Department. Based on records review, the facility License dated 5/27/2020 indicates a hospice waiver approval for two residents. According to the Licensee, they were in the process to submit an exception for the third resident receiving hospice services. LPAs discussed with the Licensee, hospice care waiver regulation and the importance to obtain a facility hospice care waiver/exception from the Department prior to accept or retain a resident receiving hospice services. LPAs provided required documentation to be submitted to CCL for resident's exception review: - Written request for hospice exception that includes resident information (name, DOB, etc) why resident is going on hospice, and how staff will provide care for the resident in a way that does not impact other residents. - Current physician’s report (LIC 602), and updated appraisal and care plan that addressees all provisions of care to ensure client's needs are being met. - What hospice agency will be providing care for the resident including frequency and type of service. - Hospice Care Plan. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. An immediate civil penalty in the amount of $500 . Exit interview conducted with Licensee and a copy of this report was given.