Facility Evaluation Report

At approximately 8:45 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Case Management - Legal/Non-compliance visit and was greeted by Caregiver Nathaniel Neish. Caregiver Roslin Sadullah arrived at 2:00 PM. Forever Sarahs Anna Home is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for four (4) residents. One (1) resident can be non-ambulatory. Three (3) residents must be ambulatory. Upon arrival, LPA was informed that there were three (3) residents in care and one (1) staff members on-site. At approximately 9:10 AM, LPA reviewed the Facility's Staff Roster and found that one (1) staff members (S2) was not background cleared on Guardian. This deficiency will be cited. A civil penalty is being issue for this deficiency.

On 11/8/2024, licensee Jenero Jefferson visited the Santa Rosa Regional Office and agreed to be placed on a non-compliance plan for a period of two years. Parties discussed multiple areas of concern including but not limited to the following:

· Licensee did not comply with a recent audit conducted by the Department

· Licensee did not notify licensing that all properties are in foreclosure.

· Licensee is having financial issues that have resulted in the regional center paying taxes that are the responsibility of the Licensee and staff have received delays in receiving their paychecks.

· Licensee to ensure all documents that were requested by the Community Care Licensing (CCL) auditor to be sent to CCL no later than Tuesday, November 12, 2024.