Routine inspection·October 7, 2025

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual inspection of facility. LPA met with Licensee/Administrator Kelly Sturgeon. This Residential Care Facility for the Elderly is single story with 5 bedrooms that has been approved by the Petaluma Fire Department for 6 Nonambulatory residents. Hospice waiver has been approved for 4 residents. There is a total of 6 residents, 5 with a diagnostic of dementia, and 2 are currently on Hospice. LPA toured the facility on 10/7/2025 at 8:25 AM with licensee/administrator Kelly Surgeon facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices although auditory devices at front door and back door were not turned on (see LIC809D). Fire Extinguisher was found to be last charged on 3/15/2025 at the time of the visit. Combination smoke and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility on 10/7/2025. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations and grocery delivery to arrive today. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored under cabinet in the kitchen which was unlocked (see pics & LIC 809D). There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and slip-resistant mats, strips, or flooring in all bathtub and shower floors as required by Title 22 regulations. All bedrooms have lighting & appropriate furnishings. At approximately 9:15AM LPA conducted a review of six resident & three staff records as well as resident’s medications. LPA reviewed resident’s files on 10/7/2025 and learned that 6 of 6 residents have an updated re-appraisals/needs & care plans and updated physician’s assessments (LIC 602A). Continue on LIC809-C Continue from LIC809: Medications are centrally stored, although at approx. 8:30am LPA observed unlocked cabinet in the facility office area between kitchen and dining room (see pics & LIC809D). The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 10/7/2025 at 10:15 AM. LPA reviewed a sample of staff records at 10:45AM on 10/7/2025 and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. Direct care staff annual training requirements for 2024/2025 are on file. LPA was presented with proof of CPR & 1 st Aid certification for staff that files were reviewed although 1 staff only had CPR/AED (see LIC809D). LPA reviewed health records for staff and observed 1 staff (S1) not having proof of TB results on file (see LIC 9102 Advisory Notes) Administrator sending. Kelly Sturgeon Administrator Certificate # 7007364740 expires on 1/5/2027. Disaster Drills have been conducted quarterly, in different shifts with the last being on 9/22/2025. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. LPA Hansen is requesting Licensee to update the following documents by 10/31/2025: LIC 308 Designated LIC 309 Administrative Organization LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan – if changes LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurance