Villa Seville

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived announced to conduct an annual inspection and was greeted by licensee Catherine Hamilton. Facility does not currently have residents in care. Once residents are admitted, licensee will submit proof of required liability insurance. Administrator certificate for Catherine Hamilton #6035280740 expires 2/2/2027. All fees are current as of this time. Facility is a two story residence consisting of two floors. Top floor has six (6) bedrooms, two (2) staff rooms, four (4) resident bedrooms, and two (2) resident bathrooms. On the first floor there are two (2) non-ambulatory resident bedrooms, one (1) full bathroom, dining room, kitchen, living room, and family room. The facility has a west set of stairs and an east set of stairs. The facility received a fire clearance approved on 1/6/2025 by Santa Rosa Department Fire Prevention for two (2) non-ambulatory residents in rooms 1 and 2 on the first floor and four (4) ambulatory residents in rooms 3,4,5, and 6, on the second floor. At approximately 9:30am LPA and licensee 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. LPA observed locked closet to contain cleaning supplies. 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 Continued on 809C... continued from 809... mats and grab bars. Facility has designated staff bathroom. LPA advised if staff bathroom is utilized by residents then no common towels can be present. Water temperature in sinks measured at 120.2 degrees F in the kitchen, 101.4 degrees F in the upstairs bathroom on the east side of the house and 117.1 degrees F in the upstairs bathroom on the west side of the house. Two (2) of these temperatures are measuring outside of the allowable range of 105 to 120 degrees F. Licensee advised that there are two (2) water heaters in the facility. LPA advised licensee that water heaters need to be adjusted so that water gets hot within a reasonable amount of time, but not too hot so as to be outside of the allowable range. Licensee will work with water heater to get it adjusted to be within allowable range. Fire extinguishers are new and showing as fully charged. LPA advised once residents are in care that fire extinguishers should be easily located and readily accessible. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility has a backup generator for use during a power outage. Alarms on doors functional. LPA advised licensee to consider adding a stopping mechanism to the upstairs windows such they cannot be opened more than a certain height so as to prohibit the ability of residents from exiting out a window. LPA and lciensee discussed medication storage and management including the use of Centrally Stored Medication Logs, Medication Adminsitration Records (MARs), and requirements for PRN MARs. LPA and Licensee discussed Emergency Disaster Plan. Licensee confirmed they reviewed the LIC610E. No deficiencies cited during this inspection. 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 Liability Insurance (if residents are admitted) Exit interview conducted with licensee and a copy of this report given.the state’s words, verbatim · CDSS document, Apr 20, 2026

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.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Hansen arrived announced to conduct a Pre-licensing Subsequent Facility Inspection and met with Applicants Alvin & Catherine Hamilton. A pre-licensing inspection was completed on 03/17/2025. During today’s visit LPA observed the following items: * All beds are equipped with mattress pads * Functioning auditory alarm has been placed on kitchen exit door * All bathrooms skid mats were placed in showers * Deck area debris was removed * Front gate has been repaired * Downstairs staff bathroom has lock as there is no safety bar for residents to use to sit down or get up * There are emergency evacuation chairs at the top of each staircase * Water heaters adjusted (106.1, 110.3, 111, and 113.3), which are delivering required temperature of 105 to 120 degrees F as stated per regulation * Screen has been replaced on upstairs window at top of stairs * Locks have been place on upstairs bathroom cabinet under sink containing cleaning supplies. * Keypad locks have been place on living room hallway closet to contain medications & files, as well 2nd hallway closet on other side of house containing cleaning products. Continue on LIC809-C Continued from LIC809 * All trash cans have tight fitting covers * Night lights have been placed in hallways Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulation. LPA will notify Application Unit Pre-licensing inspection is complete to proceed with the process of license. Pre-Licensing items needed to be repaired have been resolved. Pre-Licensing is now complete. No deficiencies cited at today’s inspection. Exit interview conducted with Applicant and a copy of this report was given.the state’s words, verbatim · CDSS document, Apr 10, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Hansen arrived announced to conduct a pre-licensing inspection and was greeted by applicants Alvin and Catherine Hamilton. Facility does not currently have residents in care. Once obtained, applicant will submit proof of required liability insurance. Facility is a two-story residence consisting of 8 bedrooms, 2 of which are staff on the 2nd story along with 4 additional resident bedrooms on the second story and two resident bathrooms. On the first floor there are 2 non-ambulatory resident bedrooms, 1 full ADA bathroom, dining room, kitchen, living room, and family room. The facility received a fire clearance approved on 1/6/2025 by Santa Rosa Department Fire Prevention for two (2) non-ambulatory residents in rooms 1 and 2 on the first floor and four (4) ambulatory residents in rooms 3,4,5, and 6, on the second floor. Facility has a dementia care program plan and a request for hospice waiver of two. Administrator certificate for Martha Marimbi #7018478740 expires on 3/21/2025. At approximately 9:00am LPA/Applicant toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed emergency supply of non-perishable food and water. All resident rooms #1-6 are furnished per regulation with a bed, lamp, bedside table, and dresser. The second story houses laundry, and across is bathroom with locked cabinet under sink for cleaning and laundry supplies. Cleaning supplies will also be stored in a secured closet in hallway next to living room which will have a keypad lock as it will also store medications & files. Auditory alarms on all doors observed to be functional except kitchen exit door. There is a wraparound deck and on side of the driveway has an electric lift and easily accessible to non-am clients and a ramp in the back of the house. Water temperatures read at: 122.7, 126.1 and 127.5 degrees F which needs to be adjusted to 105-120 degrees F as stated per regulation. Continued on LIC809C... Continued from LIC809... Items required to be repaired/addressed before licensure: * Beds to be equipped with mattress pads. * Auditory alarm on kitchen exit door. * Downstairs staff bathroom, either lock or bar for residents if use. * All bathrooms skid mats available need to be placed in shower. * Deck area has debris that needs to be removed & around outside of deck to fence. * 2 evacuation chairs to be placed at top of each staircase. * Water heater needs to be adjusted to deliver required temperature of 105 to 120 F degrees as stated per regulation. * Window screen to be replaced on upstairs window at top of stairs * Locks to be placed on upstairs bathroom cabinet under sink containing cleaning supplies. * Keypad lock to be placed on living room hallway closet that will contain medications & files. * Kitchen trash can with tight fitting cover * 2 Night lights in hallway * Front gate repair to be finished Smoke and carbon monoxide detectors (combination) are hardwired throughout house and functioning. Four [4] fire extinguishers present and purchased 2025. First aid kit present with all required items. LPA observed all required postings including the CCL Complaint Poster, Long Term Care Ombudsman Poster, Resident's Rights, and the rights to Resident and Family Councils. Activity calendar and sample of menu submitted to the Centralized Application Unit (CAB). Applicant agreed to notify Community Care Licensing once all repairs and personal accommodations are completed. LPA will conduct a subsequent visit to confirm required repairs had been completed. LPA will notify CAB analyst. LPA/Applicant reviewed and completed Component III orientation. Exit interview conducted with Applicant and a copy of this report given.the state’s words, verbatim · CDSS document, Mar 17, 2025