Tree Haven Estate 1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Administrator Martha Marimbi arrived later. Administrator certificate number 7018478740 expires 3/21/27. Facility currently has six (6) residents in care, none of which are currently on hospice. At approximately 9:45am LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Most food was found to be stored in a safe manner with open items covered, but not labeled with opened date. Boxes of pancake mix and a box of soup were found to be expired as of 2024. Bags of cereal found open and unsealed. Single serving cups of yogurt found open and not properly sealed. LPA and Admin discussed food storage and maintaining proper seals once food is opened. Drawer containing sharps accessible to residents in care, drawer had locking function but lock broken. LPA observed kitchen cabinet under sink to contain disinfectants and cleaning supplies accessible to residents in care, cabinet did not have a locking function present (deficiency cited, see 809D) All other cleaning products and laundry soaps are locked in a closet outside and inaccessible to residents in care. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 110.9 degrees F in the kitchen, 112.9 degrees F in the cottage, 109.7 degrees F in the main bathroom, and 111.2 degrees F in room #2, all of which are Continued on 809C... Continued from 809... within the allowable range of 105 to 120 degrees F. Facility bathroom in kitchen had small puddle of urine present on floor on left hand side of the toilet (deficiency cited, see 809D). Fire extinguishers were last inspected 02/06/25. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility has fire alarm hardwired and serviced by vendor, last date of annual service was September of 2025 and last date of semi-annual service was March of 2025. Facility’s last quarterly disaster drill was not conducted within the quarter. LPA and Admin discussed ensuring quarterly disaster drills are conducted. Facility has a backup generator for use during a power outage. At approximately 12:30pm LPA conducted a review of six (6) out of six (6) resident files. LPA discussed with Admin importance of completing resident appraisals herself. In addition to her own appraisal, if she would also like the families to fill one out, that is fine. LPA and Admin discussed reviewing physician reports carefully and making sure to note important items that may put residents at risk if exposed, including any allergies and if the resident is allowed access to grooming products and devices. LPA and Admin discussed reporting requirements. LPA discussed with Admin that CCL has never received an Incident Report from this facility (and their other facility). LPA printed regulation 87211, went over details of instances requiring reporting and the time frames in which a report needs to be submitted to CCL. LPA gave printed copy of regulation to Admin. No deficiencies cited. At approximately 1:45pm LPA conducted a review of four (4) out of four (4) staff files. Staff (S1) and (S2) did not have Health Screens on file. S2 also did not have TB (deficiency cited, see 809D). S3 did not have current 1st Aid/CPR and works their shift alone (deficiency cited, see 809D). S1, S2, S3, and S4 did not have required training on file (deficiency cited, see 809D). At approximately 2:45pm LPA and Licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. LPA and Admin discussed medication management requirements. LPA and Admin discussed TSP participation. Admin would like to participate. LPA will sign her up for TSP for medication management and reporting requirements. 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 and LIC308- Designation of Responsibility. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. 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 Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Oct 21, 2025

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Martha Marimbi. At approximately 1:30pm LPA and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Cleaning supplies are stored in locked in outside laundry room. Kitchen drawer with sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 118.9 degrees F in the bath off the kitchen, 112.4 degrees F in the cottage and 114.3 degrees F in room #2 which are all within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 2/22/24. Smoke/Carbon Monoxide detectors located throughout the facility are hardwired and serviced annually by Santa Rosa Fire Equipment Inc, last serviced on 9/2024. Facility’s last quarterly disaster drills were conducted on 9/26/24. Facility has a backup generator for use during a power outage. At approximately 2:00pm LPA conducted a review of 3 resident records. Resident (R1) did not have an appraisal on file (deficiency cited, see 809D). Continued on 809C... Continued from 809... At approximately 2:30pm LPA conducted review of 4 staff records. LPA reviewed training materials with Admin. Admin advised that the training materials used are videos inherited from the licensee and are dated 2011 or earlier. LPA observed some training materials to be printed training modules issued by Advanced Healthcare Studies, LLC but did not have a date of publication. LPA discussed either updating training materials to something current and pertinent or using an approved vendor to conduct staff training. Facility will submit pictures of updated materials to CCL if an approved vendor is not chosen. Facility will submit to CCL the pictures of the chosen materials or their selected approved vendor by 12/18/24. At approximately 3:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Resident (R2) had two medications, Indapamide 2.5mg and FeroSul 325mg, not logged on the Centrally Stored Medication log (deficiency cited, see 809D) Martha Marimbi Administrator Certificate 7018478740 expires 3/21/25. 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 LIC308- Designation of Responsibility 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 Admin. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.\ Exit interview conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Dec 4, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christi Coppo arrived announced to conduct a pre-licensing inspection and was greeted by Martha Marimbi, Administrator. Facility currently does not have residents in care. Facility has fire clearance for 8 non ambulatory residents. Bedrooms #1 and #2 and the guest house are proposed to have double occupancy. Once obtained, Administrator will submit proof of required Liability insurance. At approximately 9:00am LPA and Administrator toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed within regulation emergency supply of non-perishable food. Kitchen has locked cabinet that will be used for medication storage and file storage. LPA and Administrator discussed the open area kitchen with range. Administrator will ensure all knobs on range are removed for resident safety when staff is not actively cooking or utilizing range. Two locked drawers are dedicated for sharp knives. Administrator advised they will be changing from latch lock to magnet locks. Sample menu present in dining area as well as activity calendar. Facility is a one story residence with four bedrooms, three full and five half bathrooms, a guest house which is separate from main building that will be used as a resident room, a dedicated entertainment space, and dining and living room common areas. All resident rooms are furnished per regulation with a bed, lamp, dresser, chair and bedside table. Extra linens and bedding observed. Each bedroom has a hanging chandelier that could potentially be a safety hazard. Administrator advised they will be shortening each and every chandelier chain in order to mitigate safety risk. Smoke and carbon monoxide detectors present and functioning, last serviced September 2023. Five fire extinguishers present and last serviced on March 16, 2023. First aid kit present but missing scissors and thermometer. Per Title 22 regulation 87465(8)(D) scissors are required and per 87465(F) a thermometer is required. Administrator advised they will purchase required scissors and thermometer. Emergency lighting present and functional. LPA observed all required postings and posters present. Administrator advised that they will use personal vehicles for transportation. Continued on 809C.... Continued from 809... Water temperatures read at: 118 F in kitchen half bath, 117.7 F in main bath, 113 F in guest house, 110 F in bedroom #4, 116 F in bedroom #3, 116.2 F in bedroom #1, and 113 F in bedroom #2, all which are within regulation of 105 & 120 degrees F. Facility has sufficient items used for cooking and eating. Cleaning supplies and toxins have dedicated locked cabinet in outside laundry room. Laundry space with washer and dryer present in dedicated entertainment area, per Administrator this space will only be used in case of emergency or if outside washer and dryer malfunction. Administrator advised that all potential toxins, soaps and detergents will be stored in outside laundry area. Facility has areas inside and outside for visiting and activities. All rooms have exit sliding doors with alarms present and functioning. All windows fitted with alarms as well. alarms on and functioning at time of inspection. LPA observed guest house to be separate from main house and per Administrator is intended for resident occupancy, therefore it is required to have a call system. Per Title 22 regulation 87303(i) residents occupying the guest house will need to have the following capacity: (A) operate from each resident's living unit; (B) transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff; (C) Identify the specific resident's living unit. Facility has outdoor fountain pond with water approximately three feet deep. Pond surrounded by plastic fence measuring approximately 48 inches. Outside emergency exit paths all clear. The two exits on each side of the facility had a padlock on the gate. LPA and Administrator discussed that emergency exit gates shall not be padlocked when residents are in care. Administrator immediately removed padlocks. Administrator certificate #6051254740 for Martha Marimbi present in facility and shows expiration of 3/21/2025. The following items to be corrected and or obtained prior to LPA submission of facility's application for approval: fireplace to be adequately screened, call system present for proposed resident(s) occupying guest house, and first aid kit needs to have thermometer and scissors added to kit. Administrator to provide photos of items. Once acceptable photographic proof is received by CCL, LPA will submit facility's application for approval. Comp III reviewed and exit interview conducted with Administrator and a copy of this report given.the state’s words, verbatim · CDSS document, Nov 28, 2023