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Facility Evaluation Report

Forever Sarahs Elderly Care Corp, Santa Rosa05/02/2025Licence 496804038

Capacity4
Census2
Date signed05/02/2025 03:45:28 PM
Name of licensing program analystChristi Coppo
Name of licensing program managerVictoria Bertozzi
The inspector’s account

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. LPA contacted licensee Jenero Jefferson by telephone. Jenero informed LPA that facility has an Administrator now, he named I4 as being the new Admin and that he would be sending me all the paperwork "right now." LPA spoke to I4 and they advised they are not 21 years old yet. LPA called licensee back but received voicemail. LPA left voicemail indicating an Administrator is required to be at least 21 years old and have a current and active ARF Administrator certificate. I4 has completed course work but has yet to receive their certificate. LPA checked Administrator certificate Pending list but I4 not on it. LPA advised licensee of such and so there is actually not currently an Administrator for the facility ( deficiency cited, see 809D ).

Also, upon LPA arrival, LPA learned that S1's family is living here as of April 13, 2025: I1, I2, I3, and I4. Sometimes I5 visits I4 here at the facility now that I4 lives here. LPA checked Guardian for fingerprint clearance for I1, I2, I4, and I5. I3 is a minor child. I5 not present during LPA visit and is not living at facility. However, I1 and I2 do not have fingerprint clearance ( deficiency cited, see 809D and civil penalty assessed ). LPA advised S1 that I1, I2, and I5 cannot be present in any capacity at the facility until fingerprint clearance is granted. Per I4, I4 only lives here, they are not currently providing any care to the residents. I4 does have fingerprint clearance and is associated to another facility. LPA advised S1 they are not associated to the facility. LPA advised if I4 does start providing care to the residents they will also need to be associated. S1 advised LPA that they do not have access to Guardian themselves to associate. LPA advised to send LIC9182 to LPA for themselves and I4 along with their IDs and CCL will associate them. S1 advised LPA that they are int he process of buying the home, but does not currently have an application submitted to CCL for a license. S1 plans to

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