Country Rose Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and met with staff, Rosa Ascencio. Licensee, Leah Archer came to the facility and gave permission for caregiver to sign report. Annual fees are current. No residents receiving hospice. LPA/staff initiated a tour of the facility at 9:00 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident's bathroom measured at 117.3 degrees F which is within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required grab bars. Kitchen cabinet containing cleaning supplies was locked. Medications were centrally stored and locked. Fire extinguisher charged and serviced as of July 2025. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Exit doors have auditory alerts that were functional at time of visit. Last disaster drill was conducted on January 2026. Facility has at least two days of perishable and one week of non-perishable foods. However, LPA have a conversation with Licensee about having different fruit options other than strawberries, bananas and oranges. Required postings observed. Emergency supply of non-perishable food and water for at least 72 hours of shelter is available. At approximately 9:30am, LPA/staff observed ceiling located in the living room needs patchwork. According to staff, the Licensee has a contractor who will come to do the repairs. Continues on LIC809C... Continued from LIC809... File review was initiated at 10:00 am. Two staff files and four resident files were reviewed. Two out of five residents (R1 and R2) care plan needs to be signed by resident's responsible parties. One out of two staff (S1) did not have health screening and TB results. Staff have required First Aid and CPR certificates. Training hours were complete. Resident (R2) does not have a half bed rails order on file. There was no LIC9020 Register of facility clients/residents available (technical violation issued). LPA reviewed incident records on file are in compliance with reporting requirement regulations. At approximately 10:25am Administrator certificate for Administrator Leah Archer # 7009822740 expired on 12/23/24. LPA reviewed and confirmed that Administrator is not currently in any of the Department's list for review. Staff contacted Licensee and LPA spoke with Licensee where it was determined that Licensee has not submitted an updated application to have their certificate renewed. At approximately 11:17am, LPA/staff conducted review of medications and their records. A spot check of medications revealed that medication logs (R1, R2 & R3) have not been updated into Centrally Stored Medication Log. Licensee to submit updates of the following documents by 4/3/2026: copy of Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with staff, Licensee was notified about deficiencies found during today's visit and a copy of the report was given.the state’s words, verbatim · CDSS document, Mar 20, 2026

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Allegation investigated: -Facility did Not Meet Required Reporting Requirements.

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with Rosie Ascencio, Lead Staff. There was an allegation of facility did not meet the required reporting requirements. The Reporting Party has disclosed that R1 went to the emergency room on 10/11/2025 or 10/12/2025 due to experiencing vomiting for two straight days, but there was no supporting evidence that the facility made a report about R1’s hospitalization to the Department. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is cited on the attached LIC 9099D. Appeal Rights Given. The Department will review the information obtained to determine if any further action is needed. Substantiated Continued from LIC9099A... R1 stated that they get assistance from all staff when needed and did not provide any supportive information regarding threats made by staff to residents in care. Interviews conducted by LPA with staff (S1 & S2) indicated that they are assisting residents when they need to make a phone call to anybody, they help by locating the contact name of the person that they want to call, then they leave the room to allow them to have privacy and they ensures that residents are able to go to bed at their desire time. Although staff confirm that they use a paging system, they showed to LPA that the pager’s sounds like a bell only, and is not able to reproduce video nor audio, which could result in a violation of personal rights of residents in care. Interviews conducted with outside parties (I1) confirmed that R1 has a cellphone that they use to communicate anytime with them, at times if R1 doesn’t answer the phone due to their mental challenges, then the facility staff helps them to dial up. Based on records review of the facility visitation policy, the facility visiting hours are between 10am-7pm daily, offers telephone services as follow: “family members and friends are able to contact the facility by phone, fax or email to communicate with the resident or the resident can use the house phone to contact family or friends”. Based on interviews and records review, LPA is unable to determine if a violation of personal rights occurred at a prior date. A finding that the allegation of facility violating resident's personal rights is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding allegation of facility not meeting resident’s care needs. According to the reporting party, resident (R1) experience frequent vomiting due to illness, but the facility staff hand them a bucket instead of assisting R1 to the bathroom, night shift staff are not responding to R1’s signal calls which resulted in R1 sustaining falls and R1 has been left on the floors for extended periods of time after nighttime falls. On 10/28/25, During the tour of the facility, LPA observed two staff were on shift assisting residents with their needs, there was a pager motion sensor alarm located in R1’s bedroom by their bedside, the device is used as an alarm to alert staff if R1 moves out of their bed, which is in the facility kitchen. During the tour of the physical plant the bathrooms, resident’s rooms, facility kitchen and common areas appeared clean, free of odors and sanitary. There were some areas that could be improved with enhanced cleaning including some areas of the kitchen, but no flies were observed. Continues on LIC9099C... Continued from LIC9099C... Based on interviews conducted with residents (R1, R2 & R3), it is confirmed that staff are providing assistance with their needs and there were no concerns raised by residents in care. Interviews conducted by LPA with staff (S1 & S2) confirm that due to constant episodes of vomiting, they have facilitated a small bucket for R1 to use, but they ensured that they are assisting R1 timely and they use a paging system to alert them when R1 needs assistance. According to interviews conducted by LPA with outside parties (I1) determines that they had a meeting with the Licensee days prior to LPA’s visit to the facility, where it was discussed how to accommodate R1’s care needs by using a bedside commode to prevent R1’s frequent falls, but R1 refuses to use the commode when they need to use the bathroom, they also acknowledge the use of the paging system and they are in agreement of their utilization as an additional effort to help to meet R1’s needs, but they denied that R1 has been left on the floor for extended periods of time. However, LPA was unable to review residents’ (R1, R2, R3 & R4) care plans because records were not available at the facility for LPA's review as indicated by regulation. LPA will address resident’s records availability in case management. On 10/30/25, based on records provided by the Licensee of R1’s care plan dated 9/19/25 determines that R1 needs assistance with activities of daily living, which includes a bedside commode and bed alarm to alert staff when R1 needs assistance to use the bathroom, which is confirmed by R1’s physician report dated 9/16/25. Based on LPA’s observation, interviews and records review, there is no supporting information that the facility is not meeting resident’s care needs. A finding that the allegation of facility not meeting resident’s care needs is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Another allegation of facility is not being clean and sanitary at all times. Per reporting party, the facility has been observed extremely dirty and that flies are abundant (unknown dates). On 10/28/25, LPA conducted a 10-day visit to the facility, made observations, reviewed records and interviewed residents in care. LPA/Licensee toured the facility inside and outside and made observations. Continues on LIC9099C... Continued from LIC9099C... Based on LPA’s interviews with residents (R1, R2 & R3) there were no concerns raised about the cleanliness of the house. LPA has determined and confirmed that although the facility appeared to be clean and in a sanitary condition during today’s inspection, LPA is unable to determine if an area of the facility was unclean or unsanitary condition at a prior date. A finding that the allegation of facility is not being clean and sanitary at all times is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Lastly, the facility does not meet recommended dietary allowances for residents. Per reporting party, the facility staff is not feeding R1 enough food, ignoring R1’s requests for tea or coffee. On 10/28/25, LPA made observations and conducted interviews with residents in care. LPA toured the kitchen area with Licensee, including kitchen closet where at least one week of perishable food was observed and the refrigerator had at least two days of non-perishable foods. Based on records review, the licensee provided receipts for the month of October 2025 from various retail stores dated: 10/1/2025 on the amount of $154.53, 10/8/25 on the amount of $241.70, 10/10/25 on the amount of $150.79 and 10/13/25 on the amount of $150.90 including food items observed during tour of the kitchen area which confirmed that there were a supply of ingredients to make items on or like what was on the menu is available for residents in care. Interviews conducted by LPA with residents (R1, R2 & R3) and staff (S1 & S2) revealed that some residents prefer certain items over others, especially spicy foods, but according to residents all staff can provide a different food option for them, but interviews conducted did not necessarily indicate that food service was inadequate. Based on records review, five out of five resident’s (R1, R2, R3, R4 & R5) physician reports and care plans do not indicate that any resident has a specialized diet requirement on file. LPA learned based on interviews with staff and residents, information was not provided to support that violation occurred regarding facility staff does not meet recommended dietary allowances for residents. A finding that the allegation of the facility is not meeting recommended dietary allowances for residents is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Nov 14, 2025 · control 21-AS-20251022160949

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1(D) · Plan of correction due date: Nov 26, 2025

Type B - 87211(a)(1)(D) Reporting Requirements. The licensee shall send a written report, within seven days, to the licensing agency and the person responsible for the resident when any incident occurs which threatens the welfare, safety or health of any resident. This requirement is not met as evidenced by: Based on LPAs interviews and record review the facility failed to submit an incident report for R1 incident which required hospitalization which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 14, 2025

Plan of correction: Licensee agrees to submit incident reports for R1’s current incident and conduct a staff training pertaining to reporting requirements submitting IR's and training roster with topics covered to CCL by POC.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Cuadra arrived unannounced to the facility to conduct a case management visit to cite deficiencies discovered during a complaint investigation and met with Lead Staff, Rosie Ascencio. LPA learned through reviewed records and interviews conducted on 10/28/25 with Licensee that the facility failed to have resident’s (R1, R2, R3 & R4) care plans available to the licensing agency for review, which has been determined an ongoing issue during licensing visits. LPA had previously discussed with the Licensee Title 22 requirements regarding residents and staff records availability for licensing agency review. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Nov 14, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(d) · Plan of correction due date: Nov 26, 2025

Type B - 87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, & copy upon demand during normal business hours…This requirement was not met as evidence by: Based on LPA's record review and interview with Licensee, the facility did not have available resident’s (R1, R2, R3 & R4) care plans when requested by CCL, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 14, 2025

Plan of correction: Licensee agreed to review regulation 87506 regarding resident records and will retain at the facility resident's records to be available to the licensing agency for review as stated by regulation. Licensee will submit self-certification (LIC9098) form acknowledging understanding of regulation 87506 by POC due date.

Allegation investigated: -Facility staff hit residents in care. -Facility staff speak inappropriately to residents in care. -Facility staff are not serving nutritious meals.

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Rosa Ascencio (staff). Facility staff hit residents in care. Per Reporting Party, on 1/25/25 staff (S1) was observed "hitting" a resident (R2) and resident (R3) during dinner time after R2 kept asking to see their long-deceased mother. In response to R2’s inquires, S1 admonished R2 “your mother has been dead a long time” when R2 continued to be distressed wanting to visit their mother, S1 responded by hitting/slapping R2 on their arm. Then R2 responded “you shouldn’t hit them like that” resulting in S1 walked over to R3 and hit them on or around their arm too. Based on records review, the licensee provided LPA with a report filed with Santa Rosa Police Department SR#250001691.0 where it was reported that the owner of the facility was observed slapping two unknown victims during dinner. The report has an unfounded case determination. LPA conducted 10-day visit on 03/11/25 toured the facility, made observations, and conducted interviews with staff and residents in care. Continued on LIC9099C... Unsubstantiated Continue from LIC9099... Based on confidential interviews conducted with (R2, R4, R5 & R6) staff who provide care and supervision are described as supportive individuals, residents disclosed that they feel safe at the house, they are not scared to express their thoughts, and they didn’t have any concerns regarding been hit or slapped by any staff or Licensee. Additionally, LPA conducted interviews with staff (S1, S2, S3 & Licensee) did not reveal any indication that staff could be handling residents in a rough manner by hitting or slapping them on their arms and they will reach out to their Supervisor if ever observed any staff hitting or slapping residents in care. Therefore, LPA was unable to determine if allegation could happen at a prior date by S1 who was providing care and supervision during the time of the alleged incidents. A finding that the complaint allegation occurs of facility staff hit residents in care is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding allegation of facility staff speak inappropriately to residents in care. The Reporting party states that S1 treats resident (R1) with rudeness and disrespect, when S1 was confronted their response was that R1 “asked too many questions”. LPA conducted 10-day visit on 03/11/25 toured the facility, made observations, and conducted interviews with staff and residents in care. Based on confidential interviews conducted with residents (R2, R4, R5 & R6) and staff (S1, S2, S3 & Licensee), there is no leading information obtained from their verbal statements resulting in inappropriate treatment or any type of rudeness or disrespect expressed from staff at the facility. A finding that the complaint allegation occurs of facility staff speak inappropriately to residents in care is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Continued on LIC9099C... Continued from LIC9099C... The last allegation regarding facility staff are not serving nutritious meals. According to Reporting Party, the quality of the food served is not fresh, they been served always canned or processed foods. An outside party have conducted a visit on 2/14/25 and observed what appeared to be canned pork, beans and potato salad been served for dinner. LPA conducted facility annual, and 10-day visit on 03/11/25 toured the facility, made observations, and conducted interviews with staff and residents in care. Based on observations made by LPA, there was a menu posted on the wall with food options, but it appears that menu is not followed due to staff cooks according to resident’s preferences expressed during the day. Also, LPA observed three residents having breakfast at the table and one resident on a wheelchair eating their breakfast and watching tv. Breakfast served included oatmeal with strawberries, hot chocolate and water. During lunch time, residents were served with chicken and veggies, juice and fruits including banana and strawberries. Although, during the tour of the facility, LPA observed at least two days of perishable and one week of non-perishable foods, LPA suggested to licensee about the benefits of having an ample variety of food supply and a technical advisory was issued to document the conversation. Based on records review, five out of five resident’s physician reports and care plans do not indicate that any resident have a specialized diet requirement on file. Based on confidential interviews conducted with residents (R2, R4, R5 & R6) did not reveal any concerns, challenges or incidents with the food service provided by the facility. Interviews conducted with staff (S1, S2 & S3) confirms that food services are adequate for residents in care, which includes resident’s food options preferences. A finding that the complaint allegation occurs of facility staff are not serving nutritious meals is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies cited during today's inspection. Exit interview conducted with staff and copy of this report was given.the state’s words, verbatim · CDSS document, Apr 10, 2025 · control 21-AS-20250305104745

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Cuadra and Contreras arrived unannounced to conduct an Annual Required Inspection and met with staff, Rosa Ascencio. Licensee, Leah Archer came to the facility and gave permission for caregiver to sign report. Annual fees are due today in the amount of $495, Licensee notified. LPA/staff initiated a tour of the facility at 9:00 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Garbage cans located in bedrooms did not have a cover and room 1 had a smell of urine (technical violation issued). Water temperature in resident's bathroom measured at 105.6 degrees F which is within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required grab bars. Kitchen cabinet containing cleaning supplies was locked. Medications were centrally stored and locked. Fire extinguisher charged and serviced as of February 2025. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Exit doors have auditory alerts that were functional at time of visit. Last disaster drill was conducted on January 2025. Facility has at least two days of perishable and one week of non-perishable foods. LPAs had a discussion with licensee regarding the benefits of having more food supply (technical advisory issued). At approximate 9:15am LPA/staff observed dry food containers did not have expiration dates. Continues on LIC809C... Continued from LIC809... File review was initiated at 10:00 am. Three staff files and five resident files were reviewed. Two out of five residents (R1 and R2) care plan needs to be updated (technical violation was issued). Two out of three staff (S1 and S2) did not have health screening and TB results. Staff have required First Aid and CPR certificates. Training hours were complete. Administrator certificate for Administrator Leah Archer # 7009822740 expired on 12/23/24. LPAs reviewed and confirmed that Administrator is currently in the Department's pending list for review. LPA/staff conducted review of medications and their records. Required postings observed. Licensee to submit updates of the following documents by 3/25/2025: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and a copy of Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with staff, Licensee was notified about deficiencies found during today's visit and a copy of the report was given.the state’s words, verbatim · CDSS document, Mar 11, 2025

The state marks this report as 8 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Office

An informal meeting was conducted today in the Santa Rosa Regional Office. Present in the meeting were Licensing Program Manager Bethany Moellers, Licensing Program Analyst Marisol Cuadra, and Licensee Leah Archer. The purpose of the informal office meeting was to discuss areas of non-compliance and observed and ongoing Community Care Licensing concerns of the operation of Country Rose Assisted Living #496803588. The Licensee was informed that this informal meeting is a part of the Administrative Action process and that further and/or repeat citations may result in a formal Non-Compliance Plan. The legal administrative action process was explained to attendees which is based on deficiencies found during annual visit conducted on March 21, 2024. Items addressed in today's meeting include but are not limited to patterns and trends in the areas below: · Fire Clearance violation of bedridden bedrooms. · General Food Requirements including good quality of food as stated in regulations. · Incidental medical and dental care services including maintaining Centrally Stored Medication log of resident’s medication as well as medication management. · Reporting Requirements of incidents occurred at the facility were not notified to CCL. · Personnel Records on file must be complete with required documentation. · Current administrator and involvement in the facility operation including their presence on premises the number of hours necessary to manage and administer the facility in compliance with applicable law and regulation. Continued on LIC809C... Continued from LIC809... Documents requested during informal meeting to be submitted to CCL by 04/30/2024: · Licensee to submit updated LIC500 personnel summary and include all staff specific days/hours on shift, including administrator. Ensure administrator hours are business hours, Monday through Friday (the min 20 hours). · Licensee to develop policy identifying staff member responsible for ensuring all deficiencies are addressed, special incident report is submitted to designated agencies. Failure to submit the above documentation may result in the Department seeking further action. Licensing staff discussed Technical Support Program (TSP) that offers advice, guidance, a review of facility operation, discusses best practice, and required regulation/HSC compliance. Licensee agreed to contact the Department if they consider that benefit of TSP. No deficiencies cited during today’s informal conference visit. Copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 24, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and met with Caregiver, Rosa Ascencio. Licensee, Leah Archer was available by phone and gave permission for caregiver to sign report. Required postings were observed. Contact information was reviewed. LPA/staff initiated a tour of the facility at 9:00 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident's bathroom measured at 114.7 degrees F which is within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required grab bars. Kitchen cabinet containing cleaning supplies was locked. Medications were centrally stored and locked. Fire extinguisher charged and serviced as of February 2024. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Exit doors have auditory alerts that were functional at time of visit. Last disaster drill was conducted on February 2024. Facility has at least two days of perishable and one week of non-perishable foods. At approximate 9:15am LPA/staff observed one can of dark red kidney beans expired as of May 2023, one can of mixed vegetables expired as of 1/21/2024 and a classic yellow mustard expired as of 5/1/2021. File review was initiated at 9:30 am. Three staff files and five resident files were reviewed. One out of five residents (R1) care plan needs to be updated a technical violation was issued. Also, LPA had a discussion with Licensee via phone about medical assessments and mild cognitive diagnosis because some residents have not been evaluated for a couple years. Licensee agreed to have resident re-assessed by their physician to confirm that they have the same diagnosis, and technical advisory was issued. Staff have required First Aid and CPR certificates. However, one out of three staff (S1) file is missing, but LPA confirmed that S1 has been associated and cleared in Guardian website as of 3/14/24. Licensee confirmed to LPA that S1 just started a week ago, and ensured to LPA that they are only shadowing staff. LPA explained to Licensee that S1 needs to have required documentation on file. Administrator's certificate for Leah Archer 6033354740 expires 12/23/2024. Continued on LIC809C... Continued from LIC809... At approximate 9:45am LPA/staff conducted a spot of medications and their records were reviewed. However, five out of five resident's (R1, R2, R3, R4 & R5) medications were not entered into the Centrally Stored Medication log. Per staff, R2 was hospitalized between March 7, 2024 and discharged on March 12, 2024, but LPA reviewed incident reports for this facility submitted to CCL and the Department was not notified about R2's hospitalization. The following medication prescribed to R2 have not been given as prescribed by their physician: Ezetimibe 10mg (1 tab by mouth at bedtime), Trazadone HCL 150mg (2 tabs by mouth at bedtime), Carvedilol 12.5mg tab (1 tab by mouth twice daily), Lisinopril 40mg (1 tab by mouth daily), tradjenta 5mg (1 tab by mouth daily), start dates of medication had discrepancies with amount of medication on hand. At approximate 10:30am, LPA/staff observed that resident (R2) who is bedridden is occupying room #2, which is not cleared by the Fire Department as a bedridden room. On 1/16/2020, the facility was granted a fire clearance for five non-ambulatory and one bedridden client that could occupy bedroom #1 or 4. However, during the physical tour of the facility and records review of residents in care, it was observed R2 occupying room #2. Licensee is operating outside the limitation of the license by accepting a bedridden resident in a non-ambulatory room. LPA/Licensee discussed the issue with R2 and provide the option to relocate resident to a bedroom cleared by the fire marshal for bedridden residents. Licensee agrees to discuss the issue with R2 to provide R2 with the option to move to a bedroom cleared by the fire marshal for bedridden residents or provide another option to CCL that would allow Bedroom #2 has fire clearance for bedridden residents. According to the licensee, R2 is not bedridden and they will reach out to R2's physician to obtain an updated physician's report (LIC602). During the visit, LPA spoke with R2 who expressed that they are not fully bedridden and they are in agreement to obtain an updated medical assessment. As a result of the fire clearance violation, an immediate civil penalty in the amount of $500 is issued today. Licensee to submit updates of the following documents by 3/28/2024: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), Emergency Disaster Plan (LIC610E) and a copy of Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted over the phone with Licensee who was informed that the Department will be scheduling an informal office meeting to address areas of concerns and overall compliance of the facility and a copy of this report was given.the state’s words, verbatim · CDSS document, Mar 21, 2024

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.