Humboldt House Lodge

Type of visit: Required - 1 Year

At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Heather Craven and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 5 residents. At approximately 8:15AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and outdoor areas. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen equipment was clean and in good repair. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required supply of perishable and non-perishable food. Emergency water was present to ensure facility can be self-sufficient for 72 hours. Emergency lighting devices were present. First aid kit was present. No pools/bodies of water are on the premises. Facility has been conducting Emergency drills every 3 months. At approximately 9:15AM, LPA reviewed 7 resident files. All resident files contained the required documentation. Reappraisals were conducted within the last 12 months. Documentation of a physician visit within the last 12 months was present. Medication records were organized and contained orders for each medication. Medications were secured in a locked cabinet. Continued on LIC809-C… At approximately 10:15AM, LPA reviewed 7 staff files. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current. All employees requiring background checks are cleared. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report Evidence of Liability Insurance No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.the state’s words, verbatim · CDSS document, Sep 15, 2026

Type of visit: Post Licensing

At approximately 2:40PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Post Licensing Inspection. LPA met with Administrator Heather Craven and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 5 residents. At approximately 3:00PM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen equipment was clean and in good repair. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required supply of perishable and non-perishable food. Emergency water was present to ensure facility can be self-sufficient for 72 hours. Facility has a generator to supply power in an emergency. Emergency lighting devices were present. First aid kit was present. No pools/bodies of water are on the premises. At approximately 3:15PM, LPA reviewed 2 of 2 resident files. All resident files contained the required documentation. Medication records were organized and contained orders for each medication. Medications were secured in a locked cabinet. At approximately 3:35PM, LPA reviewed 5 of 5 staff files. Staff files reviewed contained evidence of completed training. First Aid/CPR certification was current. All employees requiring background checks are cleared. LPA received a copy of the Evidence of Liability Insurance during visit. No citations issued during this visit.the state’s words, verbatim · CDSS document, Jan 13, 2026

Type of visit: Prelicensing

At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility announced for the purpose of conducting a pre-licensing inspection and met with Applicant Heath Craven and Cara Rasmussen. Fire Clearance has been approved for a capacity of 30 residents; 11 ambulatory, 10 may be non-ambulatory and 9 may be bedridden. The applicant has requested a hospice waiver for 5. There are currently no residents in care. LPA conducted a tour and inspection of the indoor and outdoor portions of the facility. Facility was found to be clean and at a comfortable temperature with all doors and exits free from obstruction. Fire extinguishers found throughout the facility were charged and inspected within the last 12 months. Smoke detectors and carbon monoxide detectors in resident bedrooms and throughout the facility were tested and found to be operational. Facility has fire sprinklers throughout. Front entrance has appropriate auditory alarm system and found to be functioning. Water temperature at faucets accessible to residents was measured and found to be within regulation. There was an supply of fresh linens, continence care and hygiene products available. A tour of the kitchen and food supply was inspected and found to be clean and orderly. Food items are stored in a sanitary manner. Cleaning supplies, laundry products and other toxins were properly secured in designated storage closets. Medications will be centrally stored and secure. The Emergency Disaster Plan was reviewed and shows appropriate evacuation sites. Licensee will send a copy of liability insurance to CCLD once Licensed. Component III orientation was conducted with the Applicant. The pre-licensing evaluation has been completed. License will be granted upon completion of a final review and approval from the Licensing Program Manager. This report was reviewed with applicant and a copy was provided.the state’s words, verbatim · CDSS document, Oct 20, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 30 Census (if any clients in care): 0 COMP II Participants: CRAVEN, HEATHER Interview Method: Telephone interview On 10/16/2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 16, 2025