Caring Hands at Cloverdale

Type of visit: Case Management - Other

At approximately 9:00AM Licensing Program Analyst (LPA) Chris Arnhold arrived at the home for the purpose of voluntary closure of this licensed Residential Care Facility for the Elderly. Licensee, Rose Baluro Woodward, was contacted via telephone and granted permission for LPA to inspect the home. Licensee forgot about the appointment and was out of town. The licensee initiated this facility closure with plans of closing due to plans of no longer wanting to operate as a licensed facility. LPA inspected all rooms and the exterior of the building and found no evidence that would suggest that clients are residing on the premises. Closure of this facility has been finalized. Facility was closed effective 09/18/2026. Licensee will mail the License to CCLD. Licensee understands this home can no longer provide care or supervision without a current License from the Department. Licensee may reapply in the future. At approximately 4:00PM, Licensee Rose Baluro Woodward met with LPA that the Santa Rosa Regional Office and signed this report. A copy was provided.the state’s words, verbatim · CDSS document, Sep 18, 2026

Allegation investigated: Facility is having financial issues

Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver findings regarding the above allegation and met with facility Administrator Karen Sims. During the course of the investigation LPA conducted a facility visit, conducted interviews, collected and reviewed documents. Complaint alleges that the facility is having financial issues. A witness stated that the facility has not made payments on a promissory note signed by the licensees. A witness provided the promissory note in question. On 1/16/2026 a Judgement was entered against the facility for the amount of $8,131.54 in the Superior Court of California, County of Sonoma. LPA was provided with the Judgment and Notice of Entry of Judgment Documents. As of 7/7/2026 the Judgment amount has not been paid to the plaintiff. Continued on 9099-C... Substantiated ...Continued from 9099 Based on LPA’s interviews and record review, 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. 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-9099, LIC-9099C, LIC-809D, Plan of Corrections and Appeal Rights discussed and provided to Administrator Sims. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 9, 2026 · control 21-AS-20260414140012

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87213 · Plan of correction due date: Jul 30, 2026

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 interview & record review, the licensee did not comply with the section cited above in the facility has not paid a court ordered judgement which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 9, 2026

Plan of correction: Licensee will pay the full Court ordered judgement in the amount of $8131.54 and provide proof of payment to Community Care Licensing by POC due date of 7/30/2026.

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 Caregiver (CG) Marcia Waite. Caring Hands at Cloverdale 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, six (6) of whom may be bedridden. The facility has a Hospice Waiver for four (4) residents. Upon arrival, LPA was informed that there were two (2) residents in care and one (1) staff members on-site. At approximately 12:05 PM, LPA toured the facility. All exits were clear and unobstructed. The facility's one (1) fire extinguisher was last serviced and tagged on 10/21/2025. 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. 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 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. LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to CG Waite. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Feb 26, 2026

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Post Licensing

At approximately 9:00 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required Post Licensing Visit and was greeted by acting Administrator Karen Sims. Caring Hands at Cloverdale 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, six (6) of whom may be bedridden. The facility has a Hospice Waiver for four (4) residents. Upon arrival, LPA was informed that there were four (4) residents in care and one (1) staff members on-site. At approximately 9:15 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 10:00 AM, LPA toured the facility with acting Administrator Sims. All exits were clear and unobstructed. The facility's one (1) fire extinguishers was last serviced and tagged on 10/11/2024. Food supply was sufficient. 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. 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 monthly. The last disaster drill was conducted on 7/24/2025. 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 10:45 AM, LPA reviewed four (4) resident files. Three (3) of four (4) resident files were observed to not have current LIC625 Appraisal/Needs and Services Plans. All other required documentation was observed in the residents' files. A Technical Violation will be issued. LPA reviewed three (3) staff files. Two (2) of three (3) staff files were observed to be missing annual training documentation. A Technical Violation will be issued All other required documentation was observed in the staff files. 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. Karen Sims’s Administrator Certification 6077091740 is current with an expiration date of 6/11/2027. LPA requested the following documents be submitted to Community Care Licensing by 8/15/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610E Emergency Disaster Plan Proof of Liability Insurance No deficiencies cited during today's visit. Exit interview conducted. Copy of report, LIC 9102s Technical Violations, 811 Confidential Names provided to Acting Administrator Sims. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 31, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

At approximately 8:50 AM, Licensing Program Analyst (LPA) Robert Frank arrived to conduct an unannounced Pre-Licensing visit and met with Caring Hands House Manager/Pending Administrator Karen Sims. Applicant Rose Woodward was out of town during the inspection. LPA spoke with applicant via telephone. Applicant stated that Karen Sims would become facility Administrator post-licensing. Applicant has applied for a Change of Ownership for an existing Residential Facility for the Elderly (RCFE) identified as Villas at Cloverdale (496803142). Facility currently provides care to older adults and has a dementia care program on file. Facility received an approved fire clearance dated 10/30/2024 that allows for a total capacity of six (6) non-ambulatory residents. Upon arrival, LPA was informed that there are currently four (4) residents in care. LPA conducted a physical plant walk-through. LPA observed the following: Per facility sketch, facility is a one (1) story residence with four (4) resident bedrooms, two (2) bathrooms, and common areas. Facility has one (1) small separate building on-site used for storage. The garage has been turned into a staff break area. Facility was found to be clean with all exits free from obstruction. Facility had emergency lighting. Facility's door alarms were tested and operational. LPA observed required postings including the CCL Complaint Poster and Personal Rights. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Facility's hot water temperatures for all sinks were within Title 22 Regulations of 105F to 120F. 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. Bathrooms were equipped with necessary grab bars and non-slip floors/mats were present. All resident rooms were furnished with a bed, lamp, dresser, and chair. Continued on 809-C... ...Continued from 809 Facility has sufficient items for cooking and eating. Facility has indoor/outdoor areas for visiting and activities. Facility's fire extinguishers were observed to be fully charged with an inspection date of 10/11/2024. Facility's smoke and carbon monoxide detectors were tested and operational. LPA confirmed that contents of the facility's First Aid Kit were sufficient. Component III orientation was conducted at facility with Karen Sims. LPA and House Manager discussed the following items: · Hospice Waiver - Applicant to apply for a waiver if it's decided they want hospice care in the facility · Updated Admission Agreements and Care Plans - Applicant understands that they will need to complete new Agreements and Care Plans for all residents once Facility License is approved. · Guardian background clearances and associations - Applicant understands that all current staff members associated to Villas at Cloverdale (496803142) will need to be transferred and associated to new facility license once approved. · Documents required to be submitted to Community Care Licensing for a change of Administrator. Karen Sim's Administrator Application (6077091740) was received by Community Care Licensing on 4/8/2025. No Deficiencies or Advisories given during visit. Pre-Licensing completed. Facility is ready to be Licensed as an Residential Facility for the Elderly (RCFE). LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status. Exit interview conducted. Copy of report discussed and provided House Manager/Pending Administrator Karen Sims. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 22, 2025