Burbank Manor

Type of visit: Case Management - Legal/Non-compliance

At approximately 12:40 PM Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Non-compliance Inspection and was greeted by Administrator Arlinda Gregorio. On of 12/17/2025 the licensee agreed to be on a Non-Compliance plan for two (2) years. The areas of concern were identified as: · Physical Plant · Facility in Financial distress Licensee was to ensure their follow through with responding to and participating with the Technical Support Program. The Licensee was found to be in compliance as pertains to responding to and participating with the Technical Support Program. Licensee to Submit Financial Documents to Community Care Licensing. Documents are to include bank statements for all bank accounts the facility uses for their operation, all pages, electricity bills, gas bills, cable bills, garbage bills, water bills, federal payroll tax payment records, California payroll tax payment records, and monthly operating statements LIC 401, LIC 401A and Balance Sheet LIC 403, LIC 403A. The Licensee was found to be in compliance as pertains it to sending in all required financial documents to Community Care Licensing. Continued on 809-C... ...Continued from 809 Licensee to ensure that storage boxes and excess furniture are not being stored in the back patio area so as not to cause rodent issues. The Licensee was found to be in compliance as pertains to ensuring there are not storage boxes or excess furniture being stored in the back patio area. Licensee to ensure that the staff members are not using the outdoor sheds as break/sleeping areas. The Licensee found to be in compliance as pertains to ensuring the outdoor sheds are not being used as break/sleeping areas. LPA inspected the sheds in the back yard and observed the sheds to be used only for storage. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA reviewed two (2) new employees' staff files. Two (2) of two (2) staff files were observed with all required documentation. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 6/5/2026. The City of Santa Rosa Fire Department held their Fire and Life Safety Inspection on 4/22/2026 and found no violations at the time of the inspection. Arlinda Gregorio’s Administrator Certification 70313554740 is current with an expiration date of 10/3/2027. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Administrator Gregorio. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 10, 2026

Type of visit: Case Management - Legal/Non-compliance

At approximately 12:50 PM Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Non-compliance Inspection and was greeted by Administrator Arlinda Gregorio. On of 12/17/2025 the licensee agreed to be on a Non-Compliance plan for two (2) years. The areas of concern were identified as: · Physical Plant · Facility in Financial distress Licensee was to ensure their follow through with responding to and participating with the Technical Support Program. The Licensee was found to be in compliance as pertains to responding to and participating with the Technical Support Program. Licensee to Submit Financial Documents to Community Care Licensing. Documents are to include bank statements for all bank accounts the facility uses for their operation, all pages, electricity bills, gas bills, cable bills, garbage bills, water bills, federal payroll tax payment records, California payroll tax payment records, and monthly operating statements LIC 401, LIC 401A and Balance Sheet LIC 403, LIC 403A. The Licensee was found to be in compliance as pertains it to sending in all required financial documents to Community Care Licensing. Continued on 809-C... ...Continued from 809 Licensee to ensure that storage boxes and excess furniture are not being stored in the back patio area so as not to cause rodent issues. The Licensee was found to be in compliance as pertains to ensuring there are not storage boxes or excess furniture being stored in the back patio area. LPA observed no signs of rodent activity. Licensee to ensure that the staff members are not using the outdoor sheds as break/sleeping areas. The Licensee found to be in compliance as pertains to ensuring the outdoor sheds are not being used as break/sleeping areas. LPA inspected the sheds in the back yard and observed the sheds to be used only for storage. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. 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. Toxins were observed to be stored inaccessible to residents. The facility has an infection control plan as required. The facility has a required emergency disaster plan The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 6/5/2026. The City of Santa Rosa Fire Department held their Fire and Life Safety Inspection on 4/22/2026 and found no violations at the time of the inspection. Arlinda Gregorio’s Administrator Certification 70313554740 is current with an expiration date of 10/3/2027. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Administrator Gregorio. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Case Management - Legal/Non-compliance

At approximately 1:00 PM Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Non-compliance Inspection and was greeted by Administrator Arlinda Gregorio. On of 12/17/2025 the licensee agreed to be on a Non-Compliance plan for two (2) years. The areas of concern were identified as: · Physical Plant · Facility in Financial distress Licensee was to ensure their follow through with responding to and participating with the Technical Support Program. The Licensee was found to be in compliance as pertains to responding to and participating with the Technical Support Program. Licensee to Submit Financial Documents to Community Care Licensing. Documents are to include bank statements for all bank accounts the facility uses for their operation, all pages, electricity bills, gas bills, cable bills, garbage bills, water bills, federal payroll tax payment records, California payroll tax payment records, and monthly operating statements LIC 401, LIC 401A and Balance Sheet LIC 403, LIC 403A. The Licensee was found to be in compliance as pertains it to sending in all required financial documents to Community Care Licensing. Continued on 809-C... ...Continued from 809 Licensee to ensure that storage boxes and excess furniture are not being stored in the back patio area so as not to cause rodent issues. The Licensee was found to be in compliance as pertains to ensuring there are not storage boxes or excess furniture being stored in the back patio area. LPA observed no signs of rodent activity. Licensee to ensure that the staff members are not using the outdoor sheds as break/sleeping areas. The Licensee found to be in compliance as pertains to ensuring the outdoor sheds are not being used as break/sleeping areas. LPA inspected the sheds in the back yard and observed the sheds to be used only for storage. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 12/29/2025. The next fire and emergency drill is scheduled for 3/30/2026. 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. Toxins were observed to be stored inaccessible to residents. Arlinda Gregorio’s Administrator Certification 70313554740 is current with an expiration date of 10/3/2027. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Administrator Gregorio. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Mar 27, 2026

Type of visit: Office

Acting Regional Manager – Bethany Moellers, Licensing Program Manager – Victoria Bertozzi and Licensing Program Analyst – Robert Frank met with Licensee/Administrator Arlinda Gregorio to address areas of non-compliance. On August 19, 2025, the Department received a complaint alleging staff members were sleeping in unapproved outdoor sheds and that the facility was under financial distress. Based on the complaint investigation the Department substantiated both allegations. The following areas of non-compliance were addressed today: -Physical Plant -Financial Distress The Department of Social Services Audit Division conducted an audit of the facility and based on the outcome, financial monitoring is recommended. Continued on 809-C... ...Continued from 809 In order to comply with the financial monitoring, the following items must be provided by January 15, 2025 and by April 15, 2025.: Bank statements for all bank accounts the facility uses for their operation Electricity bills, gas bills, cable bills, garbage bills, water bills Federal payroll tax payment records California payroll tax payment records Monthly operating statements LIC 401, LIC 401A and Balance Sheet LIC 403, LIC 403A. Facility is being put on a two-year non-compliance plan. Facility will be referred to Technical Support Program. 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-809D, Plan of Corrections and Appeal Rights discussed and provided to Licensee Gregorio. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Dec 17, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87205(a) · Plan of correction due date: Jan 15, 2026

87205 Accountability of Licensee Governing Body (a)The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and... with these regulations and the welfare of the individuals it serves. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in the licensee was paying the majority of bills late, including facility rent which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 17, 2025

Plan of correction: Licensee to submit to Community Care Licensing audit documents on two (2) dates. Documents are to include bank statements for all bank accounts the facility uses for their operation, all pages, electricity bills, gas bills, cable bills, garbage bills, water bills, federal payroll tax payment records, California payroll tax payment records, and monthly operating statements LIC 401, LIC 401A and Balance Sheet LIC 403, LIC 403A.

Allegation investigated: Facility is having financial issues Outdoor sheds are being used for sleeping

At approximately 11:50 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver Complaint findings regarding the above allegations and met with facility Administrator Arlinda Gregorio. During the course of the investigation LPAs Frank and Nakagawa conducted multiple facility visits, conducted interviews, collected and reviewed documents. Complaint alleges the facility is have financial Issues. Reporting Party stated that Licensee is two (2) months behind on rent when the complaint was filed on 8/19/2029. In interviews conducted with licensee Arlinda Gregorio on 8/20/2025 and on 10/1/2025 the licensee stated due to a decreased occupancy of residents at the facility they were unable to submit rent for 7/2025,8/2025 and 9/2025 by the due date per the property lease. Continued on LIC 9099-C... Substantiated ...Continued from LIC 9099 The rent for 7/2025 and 8/2025 were paid on 8/30/2025. The rent for 9/2025 was paid on 9/26/2025. The rent for 10/2026 was paid on time per the lease. Based on LPA’s interviews and expressed admission, 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, are being cited on the attached 9099D. Complaint alleges that an outside shed is being used for sleeping. During Terminix pest elimination company’s 7/1/2025 service visit the facility would not allow the inspector in the outside shed because an individual was sleeping in the shed. The facility has a large, finished two room shed in the back yard. The shed has not been approved by the fire department for occupancy. During an 8/20/2025 inspection LPA observed that the room contained dressers, hanging cloths, guitars on guitar stands as well as a desk area that had an empty can of soda and a piece of fruit. LPA further observed a full size mattress and box springs on a wooden bed frame. The shed was observed with a window air conditioner. During an inspection on 9/18/2025 LPA observed that the desk area had been cleaned and that the bed had been replaced with a couch. LPAs took Photographs of the shed during both inspections. In an interview the Licensee noted that the shed had been used as a break area in the past. Based on LPA’s interviews and observations, 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, are being cited on the attached 9099D. Exit interview conducted. Copy of LIC-9099, LIC-9099-C, LIC-9099D, Plan of Corrections and Appeal Rights discussed and provided to Administrator Gregorio. Signature on form confirms receipt of documents. ...Continued from LIC 9099 During Terminix’s 7/1/2025 service visit the inspection notes that there was no exterior rodent or wildlife evidence found. During a requested service call on 8/7/2025 the Terminix inspection documents note no rodent activity, but the facility was treated for fire ants. During a service call on 8/11/2025 the Terminix inspection notes state that rodent traps were placed around the facility as there was some evidence of rodent activity found. During a service call on 9/9/2025 the Terminix inspection notes state that rodent traps were reset in a crawlspace and that nothing was caught. In a letter dated 10/8/2025 the facility licensee stated that the back porch area has been cleared of all boxes and containers. LPA confirmed that the back porch area has been cleared of all boxes and containers. So, 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. Exit interview conducted. Copy of LIC-9099 and LIC-9099-C discussed and provided to Administrator Gregorio. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Oct 30, 2025 · control 21-AS-20250819170640

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87213 · Plan of correction due date: Nov 20, 2025

87213 Finances The licensee shall have a financial plan..., Application for License, and that assures sufficient resources...for care of residents;... and shall submit such financial reports as may be required upon the written request of the licensing agency. This requirement is not met as evidenced by: Based on observation & interviews, the licensee did not comply with the section cited above in that the facility's rent was not paid on time per the lease agreement for three (3) months which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Licensee to submit an LIC 9098 Proof of Correction stating that the facility's rent will be paid on time per the lease agreement in the future. Licensee will also submit financial records requested by Community Care Licensing by the POC due date of 11/20/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87202(a) · Plan of correction due date: Nov 20, 2025

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal...This requirement is not met as evidenced by: Based on observation & interviews, the licensee did not comply with the section cited above in the shed at the back of the facility was being used for occupancy which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Licensee to submit an LIC 9098 Proof of Correction stating that the shed in the back of the facility will only be used for storage and will not be used for sleeping or a break area to Community Care Licensing by the POC due date of 11/20/2025.

Type of visit: Required - 1 Year

At approximately 11:50 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Administrator Arlinda Gregorio. Burbank Manor is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents. The facility has a Hospice Waiver for three (3) residents. Upon arrival, LPA was informed that there were six (6) residents in care. At approximately 12:00 PM, 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 12:05 PM, LPA toured the facility with Administrator Gregorio. All exits were clear and unobstructed. The facility's two (2) fire extinguishers were last serviced and tagged on 9/15/2025. The facility was sufficiently lighted. LPA inspected five (5) 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. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 8/1/2025. 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. Continued on 809-C... ...Continued from 809 At approximately 1:00 PM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files (for residents R1, R2, R3 and R4) were observed not to have an LIC 603 Preplacement Appraisal Information form. This deficiency will be cited. All other required documentation was observed to be present in the residents' files. LPA reviewed four (4) staff files. All staff files were observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for two (2) residents. 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. Arlinda Gregorio’s Administrator Certification 7002710740 has been submitted to Community Care Licensing for renewal. LPA requested the following documents be submitted to Community Care Licensing by 11/30/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility 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-809D, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to Administrator Gregorio. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Oct 30, 2025

The state marks this report as 5 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 at the meeting were Licensing Program Manager Bethany Moellers, Licensing Program Analyst Robert Frank and Licensee/Administrator of the facility, Arlinda Gregorio. The purpose of the office meeting was to address areas of concern related to complaint 21-AS-20250819170640 which is currently under investigation. The areas of concern are the financial stability of the facility, possible rodent infestation of the facility and that the outside sheds are being used for sleeping. Discussed during this office meeting are the following: -Licensee will provide Community Care Licensing (CCL) with all correspondence related to late payment of rent for the facility by 10/8/2025. -Licensee stated they will remove all boxes and bags from back porch area. CCL obtained Terminix reports. -Licensee agrees to use the back yard sheds for storage only and agrees to provide CCL a written statement confirming use of the sheds as a storage area only by 10/8/2025. -Copy of fire clearance and facility drawings provided to Licensee at today's meeting. No deficiencies cited durin0g today's visit. Exit interview conducted. Copy of report discussed and provided to Licensee Gregorio. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Oct 1, 2025

Type of visit: Required - 1 Year

12/17/2024, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently four(4) residents in care. Facility approved/cleared for 6 non-ambulatory and hospice waiver for 3. At approximately 9:20am, LPA and Licensee toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. Medications were found to be centrally stored. All rooms were equipped with lighting, night stand, and chest of drawers. All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 113.5 degrees F which is within the range of 105 to 120 degrees F. Fire extinguishers were last inspected 09/2024. Facility conducts quarterly disaster/fire drills with the last one being conducted 9/18/2024. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Toxins, sharps and other items that could pose threat if available to residents were located in the laundry room and under the kitchen sink and were found to be secured. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. LPA conducted a review of four (4) resident records. All records had the required documentation. LPA conducted review of three (3) staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file. No deficiencies cited during today's 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: continued on LIC809-C LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC610 - Emergency Disaster Plan (Updated) Infection Control Plan (Review, update if needed) Exit interview conducted with Licensee and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 17, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hansen, arrived unannounced to conduct an Annual Required Inspection and met with Caregiver, Judith Gonzales. Licensee, Arlinda Gregorio arrived later. Per staff, the facility has four residents on hospice which is allowable per the facility Hospice Waiver, with one exception. There were three staff providing care and supervision to six residents. There are 2 residents currently with a diagnostic of dementia. LPA initiated a tour of the facility at 8:30 AM and made the following observations: Facility was a comfortable temperature with thermostat in hallway reading at 72 degrees F. Passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident bathrooms measured at 110.6 and 112.6 degrees F, within allowable range of 105 to 120 degrees F in bathroom faucets residents use. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Kitchen cabinets containing cleaning supplies were locked; although cabinet in laundry with disinfectant supplies was unlocked and Lysol disinfectant was in both bathrooms, accessible to residents in care (see LIC 809-D). Bathrooms also contained cloth, face, hand, and body towels that are now not to be commingled with other residents (see TV9102). Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked. Fire extinguisher was last inspected 9/15 2023. Smoke detectors located throughout the facility and the Carbon Monoxide detector were tested and operational. Exit doors have auditory alerts that were functional at time of visit. File review was initiated at 10:50 AM. Five staff files and six resident files were reviewed. One out of five staff did not have required First Aid and CPR certificates, but completed by end of Annual Inspection. Administrator Certificate for Licensee/Administrator, Arlinda Gregorio 6009780740, expired per Administrator 10/3/2021 and is in the process of recertification (see LIC809-D). Medications and medication records were reviewed. Training records for 2 of 5 staff records reviewed were not up to date per regulations (see TV LIC9102). Required postings were observed. Continued on LIC809C Continued from LIC809 At approximately 1:30PM, LPA reviewed 6 resident records and found 6 of 6 residents to have current physician's reports, signed admission agreements, although Reappraisals & care plans of 4 out of 6 residents were not current or did not exist (see LIC809-D). LPA reviewed Licensing Information System (LIS) with administrator who stated that is corrected and updated at this time; no need to change any of the information. In addition, LPA advised facility to check with the County regarding what is the County Emergency Plan; ensure that disaster drills are conducted in different shifts, and review facility emergency plan to ensure accuracy according to the needs of facility residents. Administrator informed Disaster Drills are conducted quarterly with the last disaster drill being conducted on 9/1/2023. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. LPA Hansen is requesting facility to submit the following documents to CCL by 12/19/2023: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Current Administrators Certificate Copy of Control of Property Recent updated Lease Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Nov 28, 2023

The state marks this report as 9 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.