Creekside Place

Type of visit: Required - 1 Year

On 07/14/2026 at approximately 09:30AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to conduct 1-Year Required visit of this licensed Residential Care Facility for The Elderly (RCFE). LPA was greeted by House Manager, Carolina Rodas-Reyes. Administrator, Kelly Sturgeon wasn’t available. Facility has an approved fire clearance for capacity of six (6) non-ambulatory, of which one (1) may be bedridden. The facility currently approved hospice waiver for capacity of four (4) individuals. Upon arrival, LPA was informed that there were six (6) residents in care and one (1) staff member on-site. Facility is a 1 story building with five (5) Resident bedrooms, 2 bathrooms, and common spaces. 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 10:25AM, LPA and House manager toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Staff were in the process of preparing lunch and cleaning up kitchen at the time of this inspection. Toxins are stored inaccessible to residents. Water temperature measured 108.2 degrees F which is within regulation between 105- and 120-degrees F at faucets accessible to residents. Fire Extinguishers found to be last charged on March 2026 at the time of visit. Carbon Monoxide and smoke detectors were present and in order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in a cabinet in the living room. Continued on LIC809-C... Continued from LIC809… LPA reviewed three (4) resident records and found all residents have current care plans, signed admission agreements, and physician's report on file. However, the facility failed to obtain the most current resident medical assessment for a resident's file (Technical Violation Given). The LPA is requesting that updated medical assessments for all residents be submitted to Community Care Licensing (CCL) by August 4, 2026. Failure to submit the requested documents by the deadline may result in a citation. Medication records aren thorough, Facility failed to maintain appropriate centrally stored medication log two (2) of four (4) residents (Technical Violation Given). The house manager corrected the log during the visit. LPA reviewed three (3) staff records. All records did contain documentation of completed training records as required. Evidence of current first aid and CPR training were current. LPA was presented with proof of current CPR & 1st Aid certification. Administrator Certificate for Kelly Sturgeon #7007364740 expires on 01/05/2027. The LPA reviewed the facility emergency disaster plan. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 06/05/2026. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by due date of 07/26/2026: -LIC 308 Designation of Facility Responsibilities -LIC 500 Personnel Summary -LIC 610 Emergency Disaster Plan (Last page) -LIC 9020 Register of Facility Client’s/Resident’s -Copy/Proof of Updated Certificate of Liability Insurance No deficiencies were observed in the areas inspected, No citations were issued during today’s visit. Exit interview conducted. Copy of report provided to the house manager. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 14, 2026

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: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced at 8:15AM to conduct an annual inspection of the facility. LPA met with staff/designee Danielle Nunez as Licensee/Administrator Kelly Sturgeon was not available. Facility is single story with 5 bedrooms that has a fire clearance by the Petaluma Fire Department granting 6 Non-Ambulatory of which 1 may be bedridden (rm 4). Hospice waiver granted for 4 residents. There is a total of 6 residents, 3 with a diagnostic of dementia. There is 1 resident currently on Hospice. LPA toured the facility on 7/29/2025 at 8:30 AM with designee; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices. Fire Extinguisher was found to be last charged on 3/22/2025 at the time of the visit. Smoke detectors & combination carbon monoxide were found to be operational during the visit. Hot water temperature measured between 110.3 degrees F and 112.1 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 2 resident’s bathrooms while touring facility on 7/29/2025. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of nonperishable and 7-day supply of perishable 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. Facility oven and stove have protective mechanisms of buttons that must be held for over 5 seconds before heating element will turn on to prevent burns or fire, as per Title 22 regulations. Toxins are stored in a locked cabinet in the kitchen and under locked bathroom sink cabinets. Sharps are kept in locked kitchen drawer. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied hand soap dispensers. Bathrooms contained necessary grab bars and slip-resistant mats, strips, or flooring in all bathtub and or shower floors as required by Title 22 Regulations. All bedrooms have lighting & appropriate furnishings. Continue on LIC809-C Continued from LIC809 A review of six resident & four staff records as well as two resident’s medications was conducted. LPA reviewed resident’s files at 9:00 AM and learned that 6 of 6 residents have an updated re-appraisals/needs & care plans and physician’s assessments (LIC 602A) were complete. LPA reviewed a sample of staff records at approximately 10:00 AM 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. Kelly Sturgeon Administrator Certificate # 7007364740 expires on 1/5/2027. Medications were centrally stored in locked cabinet in the facility office area between kitchen and dining room. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 7/29/2025 at 8:45 AM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. Activities of; live ukulele player 2 times a week & accordion player 2 times a month, along with an art teacher instructs 2 times a month as well as exercise classes for range of motion with instructor 2 times a week. Facility recently went to Armstrong woods for the day jointly with some families. Disaster Drills are conducted quarterly with the last one being conducted on 7/12/2025. There were no deficiencies cited at this time. LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 8/15/2025: LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changed) LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Jul 29, 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: Case Management - Deficiencies

Licensing Program Analyst (LPA) Hansen arrived unannounced at facility for the purpose of conducting a Case Management regarding a medication error. LPA met with Administrator Kelly Sturgeon. LPA is following up regarding a self-reported Incident Report received by Community Care Licensing (CCL) on 7/30/2024 of a medication error. The error occurred at morning medication pass on 7/29/2024 while employee was dispensing medication. Caregiver inadvertently gave resident (R1) another resident’s medications during medication passing Regulation 87465(a)(4). (See LIC809-D). Hospice Dr. & pharmacy contacted regarding medications. R1 monitored with only signs of dizziness. Prescribing physician and responsible party were notified of medication error. Review of in-person (6 hr) training for medication administration was provided to caregiver on 7/30/2024. LPA was provided medication training documents. 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 providedthe state’s words, verbatim · CDSS document, Aug 6, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 7, 2024

87465 Incidental Medical and Dental Care(a) A plan... shall be developed... The plan shall... provide for assistance in obtaining such care, by compliance with the following:(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced.by. Based on document review and interview with Administrator, Licensee did not comply with the section cited above. R1 did not receive medication as prescribed due to caregiver not wearing glasses and giving R1 another residents medication. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 6, 2024

Plan of correction: Facility has provided in service Medication Training. POC cleared at visit.

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual inspection of the facility. LPA met with Licensee/Administrator Kelly Sturgeon for the visit. There is a total of 6 residents 4 with a diagnostic of dementia. There is 1 resident currently on Hospice. LPA toured the facility on 7/16/2024 at 8:45 AM with Administrator; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices. Fire Extinguisher was found to be last charged on 3/18/2024 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured between 109.4 degrees F and 110.8 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 2 resident’s bathrooms while touring facility on 7/16/2024. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of nonperishable food with a delivery of perishable arriving today per licensee. 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. Sharps are kept in locked kitchen drawer. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied 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. A review of five resident & three staff records as well as two resident’s medications was conducted. LPA reviewed resident’s files at 9:30 AM and learned that 5 of 5 residents have an updated re-appraisals/needs & care plans and physician’s assessments (LIC 602A). LPA reviewed a sample of staff records at 10:15 AM 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. Continue on LIC809-C Direct care staff annual training requirements for 2024 are on file. LPA was presented with proof of CPR & 1st Aid certification for staff that files were reviewed. Kelly Sturgeon Administrator Certificate # 6023921740 expires on 1/5/2025. Medications were centrally stored in locked cabinet in the facility office area between kitchen and dining room. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 7/16/2024 at 11:05 AM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. Disaster Drills are conducted quarterly with the last one being conducted on 5/17/2023. There were no deficiencies cited at this time. LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 7/31/2024: LIC 308 Designated (if changes) LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changed) LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Jul 16, 2024