Senior Care Records.

Facility Evaluation Report

Forever Sarahs Elderly Care Corp, Santa Rosa12/27/2024Licence 496804038

Capacity4
Date signed12/27/2024 03:08:37 PM
The inspector’s account

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a plan of correction visit and was greeted by caregiver. Licensee Jenero Jefferson was not available to come to the facility, was not available by phone and their voicemail box was full, so LPA could not leave a message.

On 12/19/24 LPA conducted a Case Management at which the licensee was cited for a deficiency in Health and Safety Code (HSC)1562.2(b)(1) for which the following plan of correction was agreed upon: Licensee to provide a written statement outlining the current status of the facility's foreclosure and/or proof of the properties currently being in escrow in Jenero Jefferson's name via the Closing Disclosure issued by the prospective lender no later than plan of correction due date 12/20/24 .

As of today, CCL has not received the written statement from the licensee or proof of the properties currently being in escrow as outlined in the agreed upon plan of correction. Therefore, CCL is issuing a civil penalty for failure to correct deficiency HSC 1562.2(b)(1) for the period of 12/23/24 through 12/27/24 at $100 per day for a total of $500. The $100 per day civil penalty will continue to accrue until the deficiency is cleared.

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 caregiver. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted with caregiver and a copy of this report was given

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