Creekside Cottage

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual inspection of facility. LPA met with Licensee/Administrator Kelly Sturgeon. This Residential Care Facility for the Elderly is single story with 5 bedrooms that has been approved by the Petaluma Fire Department for 6 Nonambulatory residents. Hospice waiver has been approved for 4 residents. There is a total of 6 residents, 5 with a diagnostic of dementia, and 2 are currently on Hospice. LPA toured the facility on 10/7/2025 at 8:25 AM with licensee/administrator Kelly Surgeon facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices although auditory devices at front door and back door were not turned on (see LIC809D). Fire Extinguisher was found to be last charged on 3/15/2025 at the time of the visit. Combination smoke and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility on 10/7/2025. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations and grocery delivery to arrive today. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored under cabinet in the kitchen which was unlocked (see pics & LIC 809D). There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and slip-resistant mats, strips, or flooring in all bathtub and shower floors as required by Title 22 regulations. All bedrooms have lighting & appropriate furnishings. At approximately 9:15AM LPA conducted a review of six resident & three staff records as well as resident’s medications. LPA reviewed resident’s files on 10/7/2025 and learned that 6 of 6 residents have an updated re-appraisals/needs & care plans and updated physician’s assessments (LIC 602A). Continue on LIC809-C Continue from LIC809: Medications are centrally stored, although at approx. 8:30am LPA observed unlocked cabinet in the facility office area between kitchen and dining room (see pics & LIC809D). The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 10/7/2025 at 10:15 AM. LPA reviewed a sample of staff records at 10:45AM on 10/7/2025 and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. Direct care staff annual training requirements for 2024/2025 are on file. LPA was presented with proof of CPR & 1st Aid certification for staff that files were reviewed although 1 staff only had CPR/AED (see LIC809D). LPA reviewed health records for staff and observed 1 staff (S1) not having proof of TB results on file (see LIC 9102 Advisory Notes) Administrator sending. Kelly Sturgeon Administrator Certificate # 7007364740 expires on 1/5/2027. Disaster Drills have been conducted quarterly, in different shifts with the last being on 9/22/2025. 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 Licensee to update the following documents by 10/31/2025: LIC 308 Designated LIC 309 Administrative Organization LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan – if changes LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Oct 7, 2025

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Cuadra and Frank arrived unannounced to conduct an annual required – 1 yr. visit of the facility and met with Licensee/Administrator Kelly Sturgeon. There are residents receiving hospice services and diagnostic of dementia. Annual fees are current. LPAs/Licensee toured the facility at 9:30 AM, the facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices and all auditory devices were working properly. Window screen located at the side of the facility needed to be repaired (technical advisory issued). Fire Extinguisher was found to be last charged on March 2024. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Last disaster drills have been conducted quarterly with the last one being conducted on 11/13/24. Hot water temperature measured 110.8 and 111.4, which is within Title 22 regulation. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations. Toxins are stored in a locked cabinet in the kitchen. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. However, during facility tour LPAs/Licensee observed one out of six resident's rooms needed a chair (technical advisory issued). LPAs have a discussion with the Licensee regarding the importance to have a chair available in resident's room. Contact information was reviewed. Required postings were observed. The facility does not handle cash resources. Continued on LIC809C... Continued from LIC809... LPAs initiated file review at 10:30am. Six resident's files and three staff files were reviewed. All residents have current medical assessments and care plans. All staff have required training hours complete and 1st aid/CPR certificates updated. Administrator certificate for Administrator Kelly Sturgeon # 6023921740 expires on 1/5/2025. A spot check of residents' (R1) medication conducted by LPA's revealed Tylenol 8hr 650mg expired on 3/2024. Licensee discarded expired medication. Licensee agreed to submit updates of the following documents by 12/13/24: LIC 308 Designated of facility responsibility, LIC 500 Personnel Summary, LIC 610 Emergency Disaster Plan – if changes, copy of Certificate of Liability Insurance and proof of control of property. 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 with Licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Dec 6, 2024

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: Case Management - Annual Continuation

License Program Analyst (LPA) Shannan Hansen arrived at 8:15 AM to complete an unannounced annual inspection and was welcomed by staff Alondra Amezcua who contacted Licensee/Administrator Kelly Sturgeon who arrived shortly after. There is a total of 6 residents, all with a diagnostic of dementia, with 3 on hospice. LPA continued inspection with a review of six resident & five staff records as well as two resident’s medications conducted. LPA reviewed resident’s files at 8:40 AM on 10/13/2023 and learned that 6 of 6 residents have an updated re-appraisals/needs & care plans and updated physician’s assessments (LIC 602A). Medications were centrally stored in locked cabinet in the facility office area between kitchen and dining room at 10:00 AM on 10/13/2023. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 10/13/2023 at 10:15 AM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. LPA reviewed a sample of staff records at 9:30 AM on 10/13/2023 and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. Direct care staff annual training requirements for 2022/2023 are on file. LPA was presented with proof of CPR & 1st Aid certification for staff that files were reviewed although 1 staff only had CPR/AED although is signed up for First Aid today (see LIC 9102 Advisory Notes). LPA reviewed health records for staff and observed 1 staff (S1) not having proof of TB in file (see LIC 9102 Advisory Notes) Administrator sending. Kelly Sturgeon Administrator Certificate # 6023921740 expires on 1/5/2025. Continue LIC 809-C No deficiencies cited during today's inspection. LPA Hansen is requesting Licensee to update the following documents by 10/31/2023: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan – if changes LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Oct 13, 2023

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required – 1 yr. visit of the facility. LPA was welcomed by Licensee/Administrator Kelly Sturgeon. There is a total of 6 residents and all 6 with a diagnostic of dementia. There is three residents currently on Hospice. LPA toured the facility on 10/10/2023 at 12:50 PM with licensee/administrator Kelly Surgeon facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices and all auditory devices were working properly. Fire Extinguisher was found to be last charged on 3/15/2023 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility on 10/10/2023. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the kitchen. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. Resident’s beds were outfitted with mattress pads as required by Title 22 Regulations # 87307 on 10/10/2023 at 1:30 PM. LPA reviewed Licensing Information System (LIS) with licensee/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. Disaster Drills have been conducted quarterly with the last one being conducted on 9/24/2023. Continue on LIC 809-C. LPA initiated a file review of six resident files & five personnel files but were unable to complete. LPA was also unable to review medication and will return at a later date to complete annual inspection. No deficiencies cited during today's inspectionthe state’s words, verbatim · CDSS document, Oct 10, 2023