Birdie House

Type of visit: Case Management - Other

At approximately, 8:15 AM Licensing Program Analyst (LPA) Robert Frank arrived at Birdie House for the purpose of a closure inspection pursuant to voluntary closure of this licensed Residential Care Facility for the Elderly. LPA met with back up Administrator Guadalupe Rivera. Licensee Christine Woltering submitted the written notice letter of facility closure to the Santa Rosa Regional Office via e-mail on 7/22/2025. LPA inspected all rooms and the exterior of the building today and found no evidence that would suggest that any residents are residing on the premises. The closure of this facility has been finalized. Facility is closed effective 7/24/2025. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Administrator Rivera. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 24, 2025

Type of visit: Required - 1 Year

At approximately 8:45 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Caregiver (CG) Isidro Diaz. CG/Back Up Administrator (BUA) Guadalupe Rivera arrived at 9:00 AM. Administrator Christine Woltering was not at the facility, but notified via telephone by the LPA at the time of the inspection. Birdie House is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a multi-story house with residents residing on the first floor only. The facility has an approved fire clearance for six (6) non-ambulatory residents. The facility has a Hospice Waiver for one (1) residents. Upon arrival, LPA was informed that there is one (1) resident in care. At approximately 9:10 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:15 AM, LPA toured the facility with CG/BUA Rivera. All exits were clear and unobstructed. The facility's two (2) fire extinguishers were last serviced and tagged in 4/2024. The facility was sufficiently lighted. LPA inspected three (3) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Unsecured cleaning products were observed under the kitchen sink. This deficiency will be cited. Facility has an infection control plan as required. The facility has a required emergency disaster plan. Per regulation, Emergency Disaster Drills should be held quarterly. The facility did not have an Emergency Disaster Drill log. LPA was told by CG/BUA Rivera that the last Emergency Disaster Drill was conducted in 12/2024. This deficiency will be cited. Continued on 809-C... ...Continued from 809 The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. At approximately 10:00 AM, LPA reviewed one (1) resident files. The resident's files was observed with all required documentation. LPA reviewed two (2) staff files. All staff files were observed with all required documentation including First Aid and CPR certification. One (1) staff member's (S1) file did not have training documentation for 2024. This deficiency will be cited. A Civil Penalty will be assessed for this deficiency as this deficiency has occurred twice in under a year. LPA spot checked Medication for the one (1) resident. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Christine Woltering's Administrator Certification is pending renewal. The application was received on 2/19/2025. Guadalupe Rivera’s Administrator Certification 7004269740 is current with an expiration date of 4/1/2026. LPA requested the following documents be submitted to Community Care Licensing by 5/18/2025: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Proof of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809Ds, Plan of Corrections, 811 Confidential Names, LIC 421FC and Appeal Rights discussed and provided to CG/BUA Rivera. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 18, 2025

Type of visit: Required - 1 Year

At approximately 12:55PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Administrator, Guadalupe Rivera. Licensee, Christine Woltering, was unavailable during visit. Facility serves older adults and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and total capacity for 6 non-ambulatory residents of which 1 resident can be bedridden. Facility has an approved hospice waiver for 1 individual. Upon arrival, LPA was informed that there were 4 Residents in care and 2 staff members on-site. At approximately 1:00PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 1:05PM, LPA conducted a walk-though of the facility with Administrator. LPA observed the following: Facility is a two story building. The first floor is for residents and the second floor is for live-in staff members. Facility has 8 bedrooms, 2 1/2 bathrooms and common spaces. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperatures for all sinks were found to be within Title 22 Regulations of 105 to 120 degrees Fahrenheit. Facility's fire extinguishers were last inspected April 2024. Per interview with Administrator, facility's last emergency/disaster drill was conducted April 2024, but documentation was not found during visit (see technical violation, LIC9102, Health and Safety Code, 1569.695(c)). Smoke and carbon monoxide detectors were tested and operational. At approximately 1:20PM, LPA reviewed staff files, resident files, and resident medications. Files were found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. LPA observed that one staff member was missing 2023 annual training per Health and Safety Code (this deficiency has been cited, see LIC809D, Health and Safety Code 1569.625(b)(2)). Medication was centrally stored and secure. Continued on LIC809C Continued from LIC809 Administrator's Certificate for Christine Woltering (6033992740) was current with an expiration date of 02/25/2025. LPA is requesting the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Updated Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Updated Liability Insurance Active and Current Administrator Certificate Facility Documents to be submitted to Community Care Licensing (CCL) by due date of 06/29/2024. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D (Deficiency Page), LIC9102 (Technical Advisory/Violation), Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 29, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.