Pink Lady Carehome

Type of visit: Case Management - Other

At approximately 10:10 AM, Licensing Program Analyst, (LPA) Julie Florio arrived unannounced for the purpose of conducting a facility closure inspection and met with Jean Felix, Licensee. Facility operated as a Residential Care Facility for the Elderly (RCFE). Licensee informed LPA that they wish to close the facility due to personal reasons. The purpose of this inspection is to confirm the licensed services have been discontinued and verify that there are no residents in care. The last day of operation was June 3, 2026. There were no residents or staff present in the facility during today's inspection. There were five (5) residents living in the facility at the time the facility announced it's closure. All residents were assisted with placement elsewhere. At approximately 10:20 AM, LPA conducted a walk-through of the facility with Licensee and inspected all rooms and the exterior of the building. LPA observed the facility approximately fifty percent (50%) cleared out of furnishings, household items, and care equipment. Licensee agreed to email the Department a statement of the facility's intent to close and a copy of the eviction letter that was sent to clients in June 2026. Closure inspection of this facility is complete. Licensee surrendered their license to LPA during today's inspection. The Department will move forward with the closure process. LPA to finalize paperwork for closure. No deficiencies cited during today's visit. Exit interview conducted with Licensee whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jun 18, 2026

Allegation investigated: Staff is financially abusing residents.

On 05/29/2026, at approximately 4:00 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to deliver complaint investigation findings regarding LIC802 - Complaint Report #21-AS-20260501103545, which was received by Community Care Licensing (CCL) on 05/01/2026. LPA met with Teresita Buenavista, Caregiver. Licensee was contacted by caregiver via telephone and was unable to attend today's visit. On 05/08/2026 and 05/21/2026, LPA conducted interviews and obtained documents which all revealed that Resident 1 (R1) did not give written notice that they would be moving out of the facility nor was there any evidence to support the any portion of the month's rents was due to be refunded to R1 by the Licensee. Further, R1's admissions agrrement dated 05/12/2024 and signed by R1's responsible party does not indicate whether the "total monthly amountly rate set forth in the admissions agreement will" or Continued on LIC9099C... Unsubstantiated Continued from LIC9099... "will not be prorated on a daily basis upon the resident's admission to, permanent departure from, the facility during the month." While record review revealed that R2 had purchased groceries for themself on at least one occasion, an interview with R2 revealed that they purchased groceries for themself and to share with other's in the facility, because they wanted pricier, specific, bulk food items and they chose to share with others in the facility. Interviews further revealed that R2 was not asked to purchase food for themself or the facility staff or residents, but rather R2 did so on their own volition. Interviews with R2 and the Licensee further revealed that the facility staff prepared separate items for R2 in addition to the meals prepared for the rest of the facility residents and did not charge R2 extra fees for the added service. Based on interviews conducted and documents obtained, the Department received conflicting information. Based on interviews conducted, observations made, and records obtained, the allegation that staff is financially abusing residents is UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies cited. Exit interview conducted with Teresita Buenavista, Caregiver, whose signature on form confirms receipt of document(s).the state’s words, verbatim · CDSS document, May 29, 2026 · control 21-AS-20260501103545

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

At approximately 04:30 PM, Licensing Program Analyst (LPA) Julie Florio arrived at this facility unannounced to conduct a Health, Safety, and Wellfare follow-up and Case Management Legal/Non-Compliance visit and was greeted by Teresita Buenavista, Caregiver. Jean Felix, Licensee was not present in the facility and was contacted via telephone by caregiver. Licensee expressed that she is not feeling well and was unable to come to the facility for today's visit. The facility currently has two residents, one of whom is in the hospital. Licensee is closing the facility due to inability to meet current fire code requirements to continue operating at this location as an Adult Residential Care Facility for the Elderly (RCFE) with non-ambulatory residents in care. Facility was initially placed into Non-Compliance for the following reasons: Lack of Liability Insurance in the proper amounts Lack of proper funds to properly maintain facility LPA toured the facility to ensure residents were safe and secure and that there was proper amounts of food stores, power, water and heat. Facility was a comfortable temperature and had power, water, and heat. Food stores were sufficient to sustain residents in care for seven (7) days as required per regulation. LPA was able to confirm with Licensee via telephone that they still plan to issue a 60-day notice to the two remaining residents formally informing them of the facility's closure. Licensee agreed to submit a copy of a regulatory compliant closure notice to the Department by COB tomorrow, Friday, 05/22/2026. Licensee stated they are assisting the current residents with new facility placement. Continued on LIC809C... Continued from LIC809... One is away in the hospital delaying the process. Both residents and their responsible parties have been verbally notified of the facility's closure. Today, LPA followed up on requested financial monitoring documents due by 05/26/2026 for 1st Quarter 2026: January, February, and March 2026 monitoring period to include: 1. Profit & Loss statements for the months identified above or in the report 2. Rent, payroll, income & expense third party documents such as utility statements (gas, electric, etc) supporting the amounts entered on the LIC401 3. Balance sheet for March 2026, and supporting third party documents, such as liabilities (loans, credit cards) supporting the amounts entered on LIC403 4. All Bank statements used for the operation of the facility for the months identified, cash reserve documents for the facility's emergency needs 5. Current General Liability Insurance and Workers Compensation Insurance. 6. Any financial records deemed relevant to support the Licensee has an adequate financial plan, as required by law, such as Form 941, the Employer's Quarterly Federal Tax Return, & Quarterly Contribution Return and Report of Wage - DE 9. LPA will return to regional office to conduct further file review and consult with Licensing Program Manager (LPM). No citations issued during today's visit. Exit interview conducted with Caregiver whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 21, 2026

Type of visit: Required - 1 Year

At approximately 2:30 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and quarterly non-compliance visit. LPA met with Teresita Buenavista, Caregiver. Licensee was contacted via telephone by caregiver and was unable to attend today's visit. LPA attempted to contact Administrator and left them a voicemail. LPA did not receive a returned phone from Administrator during visit. Neither Licensee nor Administrator were present for today's visit. LPA was informed the facility is closing and Licensee is working on issuing 60-day notices informing the residents formally of the facility's closure. LPA was informed that Licensee is assisting the current residents with new facility placement. Facility is a Residential Care Facility for the Elderly (RCFE) with two (2) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), and is approved for 4 non-ambulatory residents, two (2) of whom may be bedridden. Facility currently has one (1) Hospice residents in care. Facility is currently on Non-Compliance for the following reasons: Lack of Liability Insurance in the proper amounts. Lack of proper funds to properly maintain facility. LPA toured the facility to ensure residents were safe and secure and that there was proper amounts of food stores, power, water and heat. Facility was a comfortable temperature and had power, water, and heat. Food stores were sufficient to sustain residents in care for seven (7) days as required per regulation. Continued on LIC809C... Continued from LIC809... Smoke and carbon monoxide detectors were tested and were operational during inspection. The fire extinguisher was observed fully charged and was last inspected 02/2025. Facility telephone was tested an operational during inspection. LPA reviewed files for the two residents in care. Both contained all the required paperwork per regulation. Caregiver informed LPA that they do not have access to the staff files or the centrally stored medications. LPA was unable to review staff files or medications during today's inspection. Caregiver informed LPA that one resident manages their own medications and the other has them pre-poured in a medication container which was observed stored in an unsecured drawer in the unlocked laundry room. LPA and LPM were able to confirm the facility currently has adequate staffing. Facility does not handle P&I cash resources for residents. LPA will return to RO to conduct further file review and consult with LPM. LPA may return at a later date to issue citations. The Department will request quarterly financial auditing documents at a future date. No deficiencies cited during today's inspection. Exit interview conducted with Caregiver, whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 8, 2026

The state marks this report as 11 pages; the online copy we transcribed has 3. 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 in the meeting were Regional Manager, Carla Nuti- Martinez, Licensing Program Manager (LPM), Bethany Moellers, Licensing Program Analyst (LPA), Star Stevenson and Jean Felix, Licensee. The purpose of the Informal meeting was to address compliance issues outlined below. Facility is currently on a 2-year non-compliance plan implemented on 8/19/2024. Fire clearance of record from 5/2020 is approved for a capacity of 6, 2 ambulatory, 2 non-ambulatory and 2 bedridden residents. A change of ownership application was received by the department, and then later withdrawn due to challenges with obtaining a fire clearance for requested non-ambulatory/bedridden residents. Licensee has agreed to work with fire department/consult company to comply with required actions and changes to retain non-ambulatory and bedridden residents. License was informed, a subsequent referral for financial monitoring will be requested per initial solvency review. Other areas of concern discussed: 1) Licensee agreed to engage with financial monitoring and provide financial records to auditor in the name of Licensee and Pink Lady Care Home. 2) Acting Administrator Continued on LIC809C Continued from LIC809 License agrees to submit by COB Friday March 13, 2026: · Written plan to comply with Fire Department/Consultant required actions for fire clearance approval. · Written consent from Property Owner to make changes to property per actions required. · Written statement of understanding, not to admit new residents into care until new fire clearance is issued. · Who will be acting Administrator? · LIC 500 -Personnel Roster A Type A deficiency is being issued for violation of Title 22 code 87405(a) which requires a qualified Administrator in place at all times. (See 809D page) Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Signature of licensee acknowledges receipt, appeal rights given.the state’s words, verbatim · CDSS document, Mar 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Mar 13, 2026

87405 Administrator-Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator... The Administrator shall have sufficient freedom... to permit adequate...management...of the facility. This requirement is not met as evidence by: Based on observation, interview and record review, the licensee did not have an administrator in place which poses an immedate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 9, 2026

Plan of correction: Licensee to provide evidence of valid Administrator in place or the detailed steps taken to get an Administrator in place by Close of Business (COB) on 03/13/2026

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

Licensing Program Analysts (LPAs) Julie Florio and Marisol Cuadra arrived at this facility unannounced to conduct a Case Management Legal/Non-Compliance visit and was greeted by staff. Jean Felix, Licensee arrived later. LPAs were following up on items that were concerning and ensure compliance with Non-Compliance Conference dated 11/19/25: HSC 1569.605 - Liability On and after July 1, 2015, all residential care facilities for the elderly - Facility failed to have a current liability insurance with required amounts. The Licensee agrees to provide a copy of the facility current liability insurance. CCR 87213 - Finances - The licensee shall have a financial plan that conforms to the requirements of Section 87155 by not later than April 15, 2026. The Department requires Licensee to submit quarterly financial statements including January, February and March 2026 operational costs of the facility, which includes the following: 1. Profit & Loss statements for the months identified above or in the report. 2. Rent, payroll, income & expense third party documents such as utility statements (gas, electric, etc) supporting the amounts entered on the LIC401 3. Balance sheet for January, February and March 2026, and supporting third party documents, such as liabilities (loans, credit cards) supporting the amounts entered on LIC403 4. All Bank statements used for the operation of the facility for the months identified, cash reserve documents for the facility's emergency needs. Continued on LIC809C... Continued from LIC809... 5. Current General Liability Insurance and Workers Compensation Insurance. 6. Any financial records deemed relevant to support the licensee has an adequate financial plan, as required by law, such as Form 941, the Employer's Quarterly Federal Tax Return, & Quarterly Contribution Return and Report of Wage - DE 9. Previously an office meeting was conducted on 11/19/2025 in the Santa Rosa Regional Office, where other deficiencies were discussed including Fire Clearance. During today's visit, LPAs toured the facility and observed the dining room was converted to a resident's room. Resident (R1) is occupying dining room, which is not cleared by the Fire Department as a resident room. The facility fire clearance dated 5/5/2020 allows for two ambulatory, two non-ambulatory and two bedridden residents. LPAs reminded the Licensee that they were not allowed to have residents in the dining room due to the room was not cleared by the fire department as a resident's room. Licensee agreed to submit STD850 form requesting an updated fire clearance along with an updated facility sketch indicating the use of dining room as a resident room for the Fire Marshall to assess bedrooms to grant or deny fire clearance. Licensee is operating outside the limitation of the license by accepting a resident in a non-cleared room. As a result of the fire clearance violation, an immediate civil penalty in the amount of $500 is issued today. LPAs confirmed that the residents were safe and secure and that there was proper amounts of food stores, power, water and heat. Facility was a comfortable temperature and had power, water, and heat. Food stores were sufficient to sustain residents in care for seven (7) days as required per regulation. At approximately 11:58am, LPAs observed screen in sliding door located in exit door #3 in shared room #4 as well as door bottom strip needs to be repaired/replaced. Also, one out of two garbage cans located in shared room #4 was observed uncovered with no lids, and containing dirty depends. LPAs will issue a technical violation for Maintenance & Operation and have a conversation with the Licensee regarding regulation indicating: "The facility shall be clean, safe, sanitary and in good repair at all times". Continued on LIC809C... Continued from LIC809C... Additionally, LPAs observed three residents (R1, R2 & R3) are currently receiving hospice services without obtaining an exception or hospice waiver increase approval from the Department. Based on records review, the facility License dated 5/27/2020 indicates a hospice waiver approval for two residents. According to the Licensee, they were in the process to submit an exception for the third resident receiving hospice services. LPAs discussed with the Licensee, hospice care waiver regulation and the importance to obtain a facility hospice care waiver/exception from the Department prior to accept or retain a resident receiving hospice services. LPAs provided required documentation to be submitted to CCL for resident's exception review: - Written request for hospice exception that includes resident information (name, DOB, etc) why resident is going on hospice, and how staff will provide care for the resident in a way that does not impact other residents. - Current physician’s report (LIC 602), and updated appraisal and care plan that addressees all provisions of care to ensure client's needs are being met. - What hospice agency will be providing care for the resident including frequency and type of service. - Hospice Care Plan. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. An immediate civil penalty in the amount of $500. Exit interview conducted with Licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Jan 21, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Jan 22, 2026

(a) All facilities shall maintain a fire clearance approved by...fire department. Prior to accepting or retaining any of the following types of persons the licensee shall notify the licensing agency & obtain an appropriate fire clearance approved: This requirement is not met as evidenced by: Based on LPAs/Licensee observation, interview and record review, the licensee did not comply with the section cited above in all by having R1 occupying a non-cleared room which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 21, 2026

Plan of correction: Licensee agreed to submit STD850 form requesting an updated fire clearance along with an updated facility sketch indicating the use of dining room as a resident room for the Fire Marshall to assess bedrooms to grant or deny fire clearance. ***Immediate civil penalty in the amount of $500

From the deficiency page — Deficiency type: Type B · Section cited: CCR87632(a) · Plan of correction due date: Jan 22, 2026

Hospice Care Waiver. In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department. This requirement has not been met as evidence by: Based on LPAs/Licensee observation, interview and record review, the licensee did not comply with the section cited above by having three residents (R1, R2 & R3) receiving hospice services without obtaining an exception or hospice waiver increase approval from the Department, which is a potential risk to the health & safety of the residents in care.the state’s words, verbatim · CDSS document, Jan 21, 2026

Plan of correction: Licensee agrees to submit to CCL required documentation to review facility hospice care exception request to clear the citation.

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

At approximately 11:10 AM, Licensing Program Analyst (LPA) Julie Florio arrived at this facility unannounced to conduct a Case Management Legal/Non-Compliance visit and was greeted by Jean Felix, Licensee. Facility was placed into Non-Compliance for the following reasons: Lack of Liability Insurance in the proper amounts Lack of proper funds to properly maintain facility LPA toured the facility to ensure residents were safe and secure and that there was proper amounts of food stores, power, water and heat. Facility was a comfortable temperature and had power, water, and heat. Food stores were sufficient to sustain residents in care for seven (7) days as required per regulation. On 11/21/2025, LPA received an email from prospective licensee stating they decided not to proceed with a change of ownership application and would cease operation of the facility effective immediately. During an in-office meeting with current licensee and prospective licensee on 11/19/2025, current licensee agreed that if prospective licensee backed out, then current licensee would submit all requested financial monitoring documentation in the name of the current license/licensee by COB, Friday, 12/05/2025 to avoid legal action against the facility. Today, LPA followed up on requested financial monitoring documents due by 12/05/2025 for 2nd Quarter 2025: April, May, June 2025 monitoring period to include: 1. Profit & Loss statements for the months identified above or in the report 2. Rent, payroll, income & expense third party documents such as utility statements (gas, electric, etc) Continued on LIC809C... Continued from LIC809... supporting the amounts entered on the LIC401 3. Balance sheet for June 2025, and supporting third party documents, such as liabilities (loans, credit cards) supporting the amounts entered on LIC403 4. All Bank statements used for the operation of the facility for the months identified, cash reserve documents for the facility's emergency needs 5. Current General Liability Insurance and Workers Compensation Insurance.6. Any financial records deemed relevant to support the licensee has an adequate financial plan, as required by law, such as Form 941, the Employer's Quarterly Federal Tax Return, & Quarterly Contribution Return and Report of Wage - DE 9. Additionally, during today's visit, Licensee provided LPA with proof of current General Liability Insurance, Workers Compensation Insurance, and a current administrator certificate for the new facility administrator, Phoebe Lomo, certificate #7030087740, effective 01/30/2025, expiration 01/29/2027. Licensee agrees to submit the following documents required for the change of administrator to the Department by COB 12/05/2025: LIC 200 LIC 308 Designation of Facility responsibility (designation of who is the administrator) Administrator Certificate First Aid Certificate Administrator Resume LIC 500 Personnel Report LIC 501 Personnel Record LIC 503 Health Screening Report - personnel TB test that shows "negative" LIC 9182 Criminal Record Exemption Transfer Request LIC 610 Emergency Disaster Plan for Residential Care Facilities for the Elderly Copy of Personal ID continued on LIC812C... Continued from LIC812C... Copy of Board of Directors' Resolution meeting minutes signed (required for all corporations) LPA will return to regional office to conduct further file review and consult with licensing program manager (LPM). No citations issued during today's visit. Exit interview conducted with Licensee whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Dec 2, 2025

Type of visit: Office

An office meeting was conducted today, 11/19/2025, in the Santa Rosa Regional Office. The following individuals were present in the meeting: Licensing Program Manager, Bethany Moellers, Licensing Program Analyst, Julie Florio, Licensee, Jean Felix and prospective new Licensee, Kristine Bernardino and spouse Ron Hael. The purpose of the informal office meeting was to discuss the current operation of the facility and continued financial monitoring compliance. This is part of the non-compliance plan facility was placed on 08/19/2024 during a formal office meeting regarding concerns the Department has surrounding the facility's financial solvency. Items addressed in today's meeting include but are not limited to observed noncompliance in the areas below: Operation of the Facility New Licensee Application Fire Clearance Financial Monitoring Documents in the Name of Current Licensee Financial Monitoring Documents Requested: April – June 2025 LIC 401, with supporting documents April, May, June 2025 utility statements April, May, June 2025 bank statements for all bank accounts the facility uses, all pages Continued on LLIC809C... Continued from LIC809... June 2025 LIC 403 with supporting documents Current General Liability Insurance Current Workers Compensation Insurance. Licensee understands that since the facility is currently licensed under Pink Lady Carehome, LLC, these documents need to be all be in the name of the current Licensee. They cannot be under any other business name or individual while the facility is still operating under current License. The prospective licensee was requested to inform the Department by COB Friday, 11/21/2025 whether they will be submitting an application for a change of ownership or whether they will be ceasing operation of the facility. If prospective licensee decides to proceed with application, they have agreed to submit this application to the centralized application bureau by COB, Friday, 12/05/2025. If prospective licensee decides to cease operation of the facility, then current licensee agrees to submit all requested financial monitoring documentation in the name of the current license/licensee by COB, Friday, 12/05/2025 to avoid legal action against the facility. No deficiencies were cited during today's office meeting. Exit interview conducted with Licensee whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Nov 19, 2025

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

At approximately 10:30AM, Licensing Program Analyst (LPA) Julie Florio arrived at this facility unannounced to conduct a Case Management Legal/Non-Compliance visit and was greeted by staff. Administrator Mary Grace Defeo was contacted via telephone and arrived at approximately 11:45AM. This facility was placed into Non-Compliance for the following reasons: Lack of Liability Insurance in the proper amounts Lack of proper funds to properly maintain facility LPA toured the facility to ensure residents were safe and secure and to ensure there was proper amounts of food stores, power, water and heat. The temperature inside the facility was comfortable and facility had power, water and heat. Food stores were sufficient to sustain residents in care for seven (7) days as required per regulation. LPA requested copies of all facility financial documents due today 09/15/2025 for 2nd Quarter 2025: April, May, June 2025 monitoring period to include: 1. Profit & Loss statements for the months identified above or in the report 2. Rent, payroll, income & expense third party documents such as utility statements (gas, electric, etc) supporting the amounts entered on the LIC401 3. Balance sheet for June 2025, and supporting third party documents, such as liabilities (loans, credit cards) supporting the amounts entered on LIC403 4. All Bank statements used for the operation of the facility for the months identified, cash reserve documents for the facility's emergency needs 5. Current General Liability Insurance and Workers Compensation Insurance. Continued on LIC809C... Continued from LIC809... 6. Any financial records deemed relevant to support the licensee has an adequate financial plan, as required by law, such as Form 941, the Employer's Quarterly Federal Tax Return, & Quarterly Contribution Return and Report of Wage - DE 9. Additionally, LPA requested a copy of any permits regarding the renovation of the facility dining area into a bedroom/staff room/office. Administrator agreed to follow up and submit. LPA will return to regional office to conduct further file review and consult with licensing program manager (LPM). No citations issued during today's visit. Exit interview conducted with Administrator whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 15, 2025

Type of visit: Case Management - Annual Continuation

At approximately 10:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual continuation inspection and quarterly non-compliance visit and was greeted by facility Staff. Mary Grace Defeo, Administrator was contacted via telephone and arrived at approximately 10:45 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care (one was away at the hospital during today's inspection). Facility has a Dementia Care Plan, a Hospice waiver for two (2), and is approved for 4 non-ambulatory residents, two (2) of which may be bedridden. Facility currently has three (3) Hospice residents in care and has a Department approved Hospice exception for the third Hospice resident. Facility is currently on Non-Compliance for the following reasons: Lack of Liability Insurance in the proper amounts. Lack of proper funds to properly maintain facility. Facility currently has proof of liability insurance in the proper amounts. LPA will return to RO to conduct further file review and consult with Licensing Program Manager (LPM) regarding the results of the solvency audit conducted. Areas of concern noted during initial annual inspection visit conducted on 04/29/2025 have been resolved. Facility conducts quarterly disaster drills with the last one conducted 04/2025. Facility's emergency disaster plan was last updated 03/2025. Continued on LIC809C... Continued from LIC809... At approximately 11:15 AM, LPA conducted file review of staff and resident files. Staff and resident files reviewed have all the required documentation per regulation. At approximately 12:10 PM, LPA conducted medication and medication record review which were observed maintained in compliance with regulation. Facility does not handle P&I cash resources for residents. Facility is currently in the process of a change of ownership and is awaiting fire inspections. No deficiencies cited during today's inspection. Exit interview conducted with Administrator, whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 11, 2025

Type of visit: Required - 1 Year

At approximately 2:00 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and quarterly non-compliance visit and was greeted by facility Staff. Mary Grace Defeo, Administrator was contacted via telephone and arrived at approximately 3:00 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care (one was away in the hospital during today's inspection). Facility has a Dementia Care Plan, a Hospice waiver for two (2), and is approved for 4 non-ambulatory residents, two (2) of which may be bedridden. Facility currently has three (3) Hospice residents in care. Administrator will submit a request for a Hospice exception to the Department for the third resident.. Facility is currently on Non-Compliance for the following reasons: Lack of Liability Insurance in the proper amounts. Lack of proper funds to properly maintain facility. LPA will return to RO to conduct further file review and consult with Licensing Program Manager (LPM) regarding the facility's non-compliance status and will follow up with facility at a later date. At approximately 2:20 PM, LPA initiated a tour of the facility and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Continued on LIC809C... Continued from LIC809... LPA observed a fold-up roll away bed in the master bedroom walk-in closet. Staff and Administrator state that it is used for their 24 hour staff who sleep in the living room when on shift. LPA informed Administrator that staff shall not sleep in a common area of the facility or any room not approved on a fire clearance for staff sleeping quarters in order to operate in compliance with regulation. Cabinets containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPA inspected one unlocked shed in the backyard which contained care equipment, holiday decorations, and personal items. LPA observed residents in their bedrooms watching TV. Facility has an internet access device designated for resident use and internet access. Facility telephone was tested an operational during inspection. Facility's fire extinguisher was observed fully charged and was last inspected 02/2025. Smoke and carbon monoxide detectors were tested and operational during inspection. LPA will return to RO to conduct further file review and consult with LPM. LPA will return at a later date to complete inspection and conduct file review and review medications and medication records. LPA may issue citations at that time. Facility does not handle P&I cash resources for residents. No deficiencies cited during today's inspection. Exit interview conducted with Administrator, whose signature on form confirms receipt of documents. Appeal rights provided.the state’s words, verbatim · CDSS document, Apr 29, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

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

At approximately 9:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Case Management Legal/Non-Compliance visit. LPA met with Administrator Mary Grace Defeo and reviewed records. This facility was placed into Non-Compliance for the following reasons: Lack of Liability Insurance in the proper amounts. Lack of proper funds to properly maintain facility. LPA spoke with Licensee via telephone during this visit. Licensee stated they never received an email from the Department regarding the documents that were requested and did not know where to send them. LPA requested all documents be sent to LPA who will then forward to the proper individuals. LPA requested copies of all utility bills, bank statements-all pages for all accounts for facility use; LIC401 and LIC403, Current evidence of Liability insurance and current lease agreement. Licensee told LPA they would be able to send everything by Monday 02/24/2025. LPA also requested documents appointing Administrator Mary Grace Defeo. LPA emailed Licensee during this visit to ensure they have the correct email address. LPA toured the facility to ensure residents were safe and secure and to ensure there was proper amounts of food stores, power, water and heat. The temperature inside the facility was comfortable and facility had power, water and heat. Food stores were acceptable. LPA received a copy of the current lease agreement from the property owner, however it has not been signed by the Licensee as of yet. No citations issued during today's visit.the state’s words, verbatim · CDSS document, Feb 20, 2025

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

A NonCompliance conference meeting was conducted today in the Santa Rosa Regional Office. Present in the meeting were Acting Regional Manager, Bethany Moellers, Licensing Program Manager, Kimberley Mota, Licensing Program Analyst Araceli Canela, and Licensee, Jean Felix. The purpose of the Non-Compliance conference was to discuss areas of non-compliance and results from the facilities financial Audit that was recently conducted. Community Care Licensing concerns regarding the licensee not having adequate financial plan required by section 87213 finances to ensure sufficient income resources generated to cover its operating expenses of the operation of Pink Lady Care Home LLC 286803898. Licensee to acquire liability insurance with adequate coverage to be in compliance of Health and Safety Code, Section 1569.605. and provide proof by September 2, 2024. Licensee to be on quarterly financial monitoring for a period of six months or until it is evident that the licensee has an adequate financial plan in place. The first due date being 10/1/2024 for (July, August and September 2024 monitoring period). Financial monitoring documents to submit for review to include utility bills, bank statements - all pages for all accounts the facility uses; LIC401 and LIC403. Facility to submit current lease agreement and provide copy to LPA Canela. Continue report see LIC809-C The licensee was provided copies of the following regulations: • Title 22, Regulation 87405 – Administrator Qualifications and Duties. • Title 22, Regulation 87205, Accountability of Licensee • Title 22, Regulation 87213 - Finance; Record • Health and Safety Code, Section 1569.605. 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.the state’s words, verbatim · CDSS document, Aug 19, 2024

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.605 · Plan of correction due date: Sep 2, 2024

Liability On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees This requirement was not met as evidenced by: Based review of facilities current liability insurance today and on 5/8/2024. Facility had proof of liability insurance but it did not meet the liability required amount per regulation requirement. This poses a potential risk to the Health & Safety of residents in care.the state’s words, verbatim · CDSS document, Aug 19, 2024

Plan of correction: Facility agrees to submit proof of liability insurance in the correct liability amounts to LPA Canela by Plan of correction date 9/2/2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR87213 · Plan of correction due date: Sep 18, 2024

Finances-87213 The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency. Such request shall explain the need for disclosure. The licensing agency reserves the right to reject any financial report and to request additional information or examination including interim financial statements. This requirement was not met as evidenced by:Based on FInancial Audit conducted by the department, Licensee failed to have an adequate financial plan. This poses a potential risk to the Health & Safety of residents in care.the state’s words, verbatim · CDSS document, Aug 19, 2024

Plan of correction: Licensee to send in written statement they will submit quarterly financial records as requested by the department. Plan of correction due 9/18/2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(b)(c)(d) · Plan of correction due date: Sep 18, 2024

Administrator - Qualifications and Dutie (b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. (c) Failure to comply with all licensing requirements pertaining to certified administrators may constitute cause for revocation of the license of the facility. (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. This requirement was not met as evidenced by:Based on FInancial Audit conducted by the department, Licensee failed to properly operate the facility financially. This poses a potential risk to the Health & Safety of residents in care.the state’s words, verbatim · CDSS document, Aug 19, 2024

Plan of correction: Facility to submit written plan on how they will be in compliance with regulation 87405 and provide requested documents to Community Care Licensing as requested. POC due date 9/18/2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR87205(a) · Plan of correction due date: Sep 18, 2024

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 establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement was not met as evidenced by : Based on FInancial Audit conducted by the department, Licensee failed to operate the facilities financial matters. This poses a potential risk to the Health & Safety of residents in care.the state’s words, verbatim · CDSS document, Aug 19, 2024

Plan of correction: Facility to submit written plan on how they will be in compliance with regulation 87205(a) POC due date 9/18/2024

Type of visit: Required - 1 Year

At approximately 9:00AM. Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Care Provider Princess Villanueva and explained the purpose of the visit. Administrator was not present during this inspection. Administrator certificate for Maria Bui is current. LPA was informed the Licensee was away from the facility purchasing groceries. LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. First Aid/CPR certification was current. Medications were also reviewed. The common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The bathrooms were clean and in good repair. The kitchen was clean and in good repair. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Medication is locked and not accessible. The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. All employees requiring background checks are cleared. No pools/bodies of water are on the premises. Staff was not able to provide LPA documentation of the last disaster/emergency drill. Licensee arrived at 12:15PM and provided LPA with documentation of a completed drill. LPA requested the following documents during this visit: Evidence of Liability Insurance LIC308, Designation of Responsibility LIC500, Personnel Summary No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.the state’s words, verbatim · CDSS document, May 6, 2024

Type of visit: Office

An Informal meeting was conducted today in the Santa Rosa Regional Office. Present in the meeting were Licensing Program Manager (LPM) Kimberley Mota, Licensing Program Analyst (LPA), Araceli Canela and Licensee, Jean Felix. The purpose of the Informal meeting was to address concerns during an inspection of 1/17/2024. Items addressed in today's meeting include but are not limited to compliance issues outlined below: · Licensee to ensure all utilities and/or items needed to run the facility, for the comfort and safety of the residents are paid on time. · Licensee to ensure the facility has a current Administrator or submits and notifies Community Licensing in writing when there is a change in Administrator. · Licensee to ensure all new staff are properly associated and have a fingerprint clearance prior to working, living or volunteering in this facility. No citations issued during todays informal meeting.the state’s words, verbatim · CDSS document, Jan 31, 2024

Allegation investigated: Facility does not have an Administrator

Licensing Program Analyst (LPA), Araceli Canela arrived unannounced, for the purpose of opening a complaint investigation, regarding the above listed allegation. LPA met with care staff, Erlinda Sonaco and Licensee, Jean Felix (S3) arrived towards the end of the visit. LPA toured the inside of the home, made observations and took statements. It was alleged the facility does not have an Administrator present or running the facility. LPA confirmed and received a statement from licensee (S3) that they have not had an active Administrator since October 31, 2023 and S3 is in search for a new Administrator. Based on statements received, Allegation, Facility does not have an Administrator, is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. Appeal Rights Given Substantiatedthe state’s words, verbatim · CDSS document, Jan 17, 2024 · control 21-AS-20240108115436

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Jan 31, 2024

Administrator - Qualifications and Duties 87405(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement was not met as evidenced by LPAs observations, and interview with licensee, and other related parties. The Licensee Jean Felix has not ensured the facility has a qualified certified Administrator on-site as required by regulation; there has not been an Administrator since Oct 31, 2023. This is a potential risk to the health and safety of all residents in care.the state’s words, verbatim · CDSS document, Jan 17, 2024

Plan of correction: Licensee to ensure that the facility has a hired Administrator on-site as required by regulations. The facility must have a qualified certified Administrator on-site to ensure the facility is operating within regulations. Submit all documents required to associate the hired Administrator, including copy of their certificate, and updated LIC500 personnel report by by 1/31/24. Plan of correction due 1/31/2024.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced and met with care staff, Erlinda Sonaco. During a complaint investigation LPA discovered an additional staff (S1) who has a fingerprint clearance but their fingerprint clearance is not associated to this facility as required. In addition, LPA observed a shut-off water notice on the door and at 1:50pm LPA verified the facility has no water as it has been shut off. LPA verified there was plenty of bottle drinking water on hand. Licensee Jean Felix arrived and provided proof that the minimum amount to restart service has been paid and at about 3:55pm the water was restored to the property. A civil penalty was assessed for $100.00 for staff S1 not being properly associated to this facility. 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.the state’s words, verbatim · CDSS document, Jan 17, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(d) · Plan of correction due date: Jan 18, 2024

87211(d) Reporting Requirements(d) The licensee shall notify the Department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their representatives, in writing within two business days of any of the following specified events, or knowledge thereof:(5) A utility company has sent a notice of intent to terminate electricity, gas, or water service on the property within not more than 15 days of the notice. This requirement was not met as evidenced by: during inspection LPA discovered the facilities water had been turned off for non payment. This is an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jan 17, 2024

Plan of correction: Facility provided proof they had paid the minimum amount to restart the water service and service was restored before 4pm. Facility to send in written plan they have a payment plan to ensure they become current on their utility bills. Proof of plan due 1/18 and follow up with LPA again by 2/1/2024 for update on any outstanding amounts due.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87355(e)(2) · Plan of correction due date: Jan 19, 2024

87355(e)(2) Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline This requirement was not met as evidenced by: during ee roster record review and confirmation with regional office, staff S1 was fingerprint cleared but not associated to this facility- This is a potential risk to the health and safety of all residents in care.the state’s words, verbatim · CDSS document, Jan 17, 2024

Plan of correction: Facility completed the required forms and sent to regional office during visit. Facility to send in a written plan they understand regulation and how facility will ensure they stay in compliance. POC due date 1/19/2024 Attention LPA Araceli Canela