Senior Care Records.

Facility Evaluation Report

Shalom House, San Rafael03/27/2026Licence 216800503

Capacity5
Census3
Date signed03/27/2026 02:35:00 PM
Name of licensing program analystCaitlynn Felias
Name of licensing program managerVictoria Bertozzi
The inspector’s account

An Office meeting was conducted today, 03/27/2026, in the Santa Rosa Regional Office. The following individuals were present in the meeting: Acting Regional Manager, Bethany Moellers, Licensing Program Manager, Victoria Bertozzi, Licensing Program Analyst, Caitlynn Felias, Analyst II, Christopher Kovarik, and Licensee , Maria Del Pilar De Olave . The purpose of the office meeting was to discuss the Licensee's lack of an active Administrator certificate.

The Department has identified that the Licensee has not had an active Administrator Certificate since 2021. The Application Certification Bureau received a renewal application packet from the Licensee on 12/02/2024 which was approved on 04/10/2025. This application covered the certification period of 2021-2023. Per the Application Certification Bureau, they received a renewal application packet which covered the certification period of 2023-2025 in February 2026 which brought Administrator to current as of 12/07/2025. Another application packet for the certification period of 2025-2027 is required in order to become current with their Administrator certificate. Per Licensee, they have completed their units for the certification period of 2025-2027 and will be mailing their documents via mail to the Administrator Certification Bureau on 03/27/2026.

Department to follow up with Application Certification Bureau regarding Licensee's Application status once documents are received.

Exit interview conducted. Copy of report discussed and provided to Licensee. Signature on form confirms receipt of documents.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction