Facility Evaluation Report

Licensing Program Analyst (LPA) Christi Coppo and Licensing Program Manager (LPM) Victoria Bertozzi arrived unannounced to conduct a case management visit and was greeted by caregiver. Licensee Jenero Jefferson was not available to come to the facility, but was reached by telephone.

On 11/8/24 licensee attended Santa Rosa regional office meeting at which they were 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 foreclosure and what their plan is in the event that the facility is not able to maintain control of property no later than POC due date 11/12/2024. As of today, CCL has not received the written statement from the licensee. LPM reached licensee by phone to advise that CCL will be re-citing HSC 1562.2(b)(1) on the attached 809D.

Additionally, per LPM phone conversation with licensee, change of property ownership of this facility and Forever Sarah's Anna Home is currently in escrow. Licensee will submit documents showing proof of escrow to CCL by no later than 12/20/24.

Lastly, Licensee was to ensure all documents that were requested by the CCL auditor to be sent to CCL no later than Tuesday, November 12, 2024. As of today, all documents requested to be sent to CCL auditor have not been received. Licensee to provide all documents to CCL no later than Monday, December 23,2024

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 .