Senior Care Records.

Facility Evaluation Report

Forever Sarahs Elderly Care Corp, Santa Rosa02/13/2025Licence 496804038

Capacity4
Census3
Date signed02/13/2025 04:22:19 PM
The inspector’s account

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to deliver findings for the above allegation 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. LPA sent text to licensee to advise purpose of visit

On 12/27/24 LPA conducted a Case Management visit at which the licensee was issued 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. On 1/3/25 LPA conducted a Case Management visit at which the licensee was issued a civil penalty for failure to correct deficiency HSC 1562.2(b)(1), for the period of 12/28/24 through 1/3/25 at $100 per day for a total of $700.Also on 1/3/25, the licensee was issued civil penalties for failure to correct deficiencies of regulations 80062(a)(1) and 80076(a)(1), for the period of 12/31/24 through 1/3/2025 at $100 per day for a total of $400 each, respectively.

As of today 2/13/25, CCL has not received a plan of correction for deficiency of Health and safety Code (HSC) 1562.2(b)(1). Therefore, CCL is issuing a civil penalty for failure to correct deficiency of HSC 1562.2(b)(1) for the period of 1/4/25 through 2/13/2025 at $100 per day for a total of $4200. The $100 per day civil penalty will continue to accrue until the deficiency is cleared. As of today 2/13/25, CCL has not received a plan of correction for deficiencies of regulations 80062(a)(1) and 80076(a)(1), respectively. Therefore, CCL is issuing a civil penalty for failure to correct deficiencies 80062(a)(1) and 80076(a)(1) for the period of 1/4/25 through 2/13/2025 at $100 per day for a total of $4200 , each respectively. 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