Facility Evaluation Report

At approximately 9:20AM, Licensing Program Analysts (LPAs) Felias and Deniz arrived unannounced to conduct a Case Management - Deficiencies Visit and met with Executive Director, Camille Brown. The purpose of the visit was to follow up self-reported incidents that were submitted to Community Care Licensing (CCL).

The Santa Rosa Regional Office (SRRO) received 3 late incident/death reports from the facility. Review of reports showed that the incidents occurred on the following dates: 03/17/2025 and 03/24/2025. Reports were received by the SRRO on the following dates: 03/27/2025 and 04/01/2025. Per Title 22 Regulations, incident reports must be submitted to CCL within seven (7) days of the incident occurring (deficiency cited, LIC809D, Regulation 87211(a)(1)).

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC809D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Executive Director. Signature on form confirms receipt of documents.