Rincon Valley Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Administrator Rahel Gurja arrived later. At approximately 9:30am LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Kitchen drawer with sharp knives locked. Cleaning supplies located in garage inaccessible to residents in care. All bedrooms were equipped with lighting, night stand, and chest of drawers. Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bar. Water temperatures in sinks accessible to residents in care measured at 119.9 degrees F in the main bath and 114.4 degrees F in the double occupancy room which are within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 8/10/26. Smoke/Carbon Monoxide detectors located throughout the facility were operational. Facility is conducting fire drills with staff, last dated 6/23/26. Facility has two gates leading to backyard, one on each side, both of which are in disrepair. Additionally, front deck has one board in disrepair. Board on back deck, located right after ramp from sliding glass door, deeply bows when pressure is applied. Admin advised facility will fix immediately. Backyard also has dried brush and dried bushes in backyard in back on right hand side across from the fig tree that could present as a fire hazard. LPA and Admin discussed removing the dried brush as well as chairs that have black and green fuzz on them. LPA and Admin discussed disposing of the old commode chair that is present in backyard. Continued on 809C... Continued from 809.... At approximately 11:00am LPA conducted a review of five [5] resident records. Facility has two (2) residents that are bedridden. Both residents are on hospice. Admin produced copies of emails sent to fire dept notifying them of resident with bedridden status. LPA did not observe any activities for bedridden resident (R1). LPA and licensee discussed activities at length at 2025 annual. Facility did not have any activities for residents. LPA and licensee discussed adding activities, especially for residents that are bedridden. During today's visit, LPA observed lack of TV, radio, or anything in R1's room that could provide sensory stimulation. LPA discussed with Admin that LPA discussed with licensee at 2025 annual facility having the same issue. Admin had caregiver immediately hook up a TV in resident's room. LPA stressed to Admin that activities that provide sensory stimulation must be maintained available as required by regulation 87219. LPA discussed with Admin resident appraisals. Currently, appraisals are completed by residents' responsible parties. LPA discussed with Admin completing the appraisals herself in addition to those completed by residents' responsible parties. LPA discussed with Admin that it is good practice to complete the appraisal herself, this will allow her to determine if a potential resident is compatible with other residents and/or if facility staff will be able to meet the care needs of resident, among other valuable uses. LPA advised Admin that LPA has this same discussion with licensee at 2025 annual. At approximately 12:00pm LPA conducted review of three [3] staff records. LPA discussed with Admin if facility admits bedridden residents, training for bedridden care must be completed by staff as required by regulation 87606(f)(3). LPA discussed with Admin Health and Safety Code 1569.69 and advised of specific subject matters required for all staff doing medication administration. LPA discussed with Admin ensuring documentation for shadowing and hands-on training is completed. At approximately 2:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. LPA went over the requirement to keep a PRN MAR/log that meets the requirements of regulation 87465. LPA advised that if a resident has a prescription for a regular medication and PRN medication of the same name but of different doses, such as Tylenol, be sure to follow the instruction on each bubble pack. Otherwise, it could look like the medication count is off. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report and Liability Insurance. No deficiencies cited. Exit interview conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Aug 11, 2026

The state marks this report as 7 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

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Administrator Fikre Gurja arrived later, certificate #7029598740 expires 1/7/27. Facility roster was reviewed. At approximately 9:30am LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Most food was found to be stored in a safe manner with open items covered, some items such as applesauce and spaghetti sauce were opened without opened dates present. Kitchen cabinet under sink was locked. Kitchen drawer with sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. Resident room #1 smelled of urine, noticeable when entering the facility. LPA advised of regulation for Managed Incontinence 87625. LPA advised that residents must be kept clean and dry and also their bedding must be kept clean and dry. Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 115 degrees F in the kitchen and 114.5 degrees F in the hall bathroom which is within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 6/19/24. LPA discussed with Admin that fire extinguishers need to be serviced annually. However, fire extinguisher showing as fully charged. Smoke/Carbon Monoxide detectors located throughout the facility were operational. Facility’s last quarterly disaster drills were conducted with each staff member in May and June of 2025, LPA observed all training dates for respective staff were within the quarter. Facility has a backup generator for use during a power outage. Continued on 809C... Continued from 809... Facility's backyard perimeter fence in disrepair in several places but primarily on the back and right hand side (if facing the backyard). Planks are loose, have fallen, are missing, have nails exposed, and have an appearance of dry rot. Backyard also has pile of discarded chairs and other items for disposal piled up on side of shed. Ramp on right hand side of facility has lifting boards needing repair. LPA and Admin discussed repairing the fence such that it is sturdy and safe. Admin advised he is waiting for trash pile to be picked up by the City of Santa Rosa. LPA advised Admin can also take to the dump, if city is taking an extended period of time. At approximately 11:00am LPA conducted a review of two [2] resident records. LPA observed resident (R1) in room #1 to have full bed rails. Per Admin, R1 was on hospice beginning 12/30/24 but graduated from hospice on 6/27/25. LPA advised that full bed rails are a prohibited condition unless resident is on hospice and has a hospice care plan that specifies the need for full bed rails. LPA reviewed hospice care plan, plan does not indicate the need for full bed rails (deficiency cited, see 809D). Per R1 physician's report and per Admin, R1 is bedridden. LPA advised facility does not have fire clearance for bedridden residents. Admin showed LPA form filled out for Santa Rosa Fire Dept (SRFD) indicating R1 was using oxygen and Admin checked a box for bed bound on the form, however fax transmission to Fire Dept not produced for LPA. Admin did produce email sent to SRFD notifying them that R1 was using oxygen, but nothing noted about bed bound or bedridden status (deficiency cited, see 809D). LPA reviewed R1's appraisal. Per, Admin, resident appraisal are completed by residents' responsible parties. LPA discussed with Admin that he needs to complete the appraisals. LPA discussed with Admin that it is good practice to complete the appraisal himself, this will allow him to determine if a potential resident is compatible with other residents and/or if facility staff will be able to meet the care needs of resident, among other valuable uses. Resident's (R2's) physician report shows faxed dated of 8/1/24, is missing diagnosis and missing physician signature and date. LPA advised Admin to be sure to review residents' physician reports/medical assessments once received in order to review changes in ambulatory status and diagnoses, as well as making sure it is signed and dated. LPA also advised that a medical assessment must be completed Continued on 809C(2)... Continued from 809C... annually, regardless of diagnosis, per regulation 87463(h). Most current appraisal for R2 completed 2022 (deficiency cited, see 809D). At approximately 12:30pm LPA conducted review of five [5] staff records. LPA discussed with Admin Health and Safety Code (HSC) 1569.625 (b)(1) and (2) and HSC 1569.625(c). LPA advised of subject matters to be covered in training. At approximately 2:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. LPA went over the requirement to keep a PRN MAR/log that meets the requirements of regulation 87465. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report Liability Insurance 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 Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was giventhe state’s words, verbatim · CDSS document, Jul 31, 2025

The state marks this report as 13 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver (S1). Caregiver (S2) arrived later. Administrator Fikre Gurja was contacted by phone. Admin out of the country. Admin gave caregiver S2 permission to sign. Facility contact information was reviewed. Facility staff roster was reviewed. S1 not associated to the facility. S1 has been working at facility since October of 2023. In addition to not being associated to the facility, S1 also does not have fingerprint clearance. Per Guardian background check system, S1 has an incomplete application and was notified of such on 9/17/2023 (deficiency cited, see 809D and *civil penalty assessed* in the amount of $500). LPA advised S2 and S1 that S1 must leave the facility and not return to work or provide any care to residents until fingerprint clearance is obtained and they are associated to the facility. At approximately 9:30 am LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. LPA and caregiver observed package of Keebler Club crackers opened but not covered or labeled with date opened. Canned goods found to be stamped with expired Best If Used By (BIUB) dates: one can of Bruce's Yam 12/22/2023, one bottle of Hidden Valley Ranch dressing 5/30/2024, two [2] cans of S&W garbanzo beans 11/18/2023, one can of Swanson's chicken broth 11/11/2023. Frozen beef steak dated 10/27/2023 (deficiency cited, see 809D). Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives was open but has locking function. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bars. However, mats in all 3 resident bathrooms were found to have black and brown substance on the underside of the mat, two of which had the substance almost covering the entire surface, one of which had varied spotting of the black substance (deficiency cited, see 809D). Continued on 809C... Continued from 809... Water temperature in sink accessible to residents in care measured at 116.9, 119.4, and 119.4 degrees F which is within the allowable range of 105 to 120 degrees F. LPA advised caregiver that the 119.4 is very close to the maximum allowable temperature of 120 degrees F, so licensee may consider turning down the water heater slightly as a preventative measure. Fire extinguishers were last inspected 6/19/2024. Smoke/Carbon Monoxide detectors located throughout the facility were operational. Facility’s last quarterly disaster drills were conducted 6/25/2024. Facility has a backup generator for use during a power outage At approximately 11:30am LPA conducted review of 5 staff records. All required documentation present. At approximately 1:30pm LPA conducted a review of 3 resident records. R1 has DX of dementia but most recent medical assessment dated 11/11/2022 and most recent appraisal dated 8/20/2022 (deficiency cited, see 809D) At approximately 2:00pm LPA and caregiver conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. During spot check of medication, LPA and S2 observed: R2 to have prescription for Lisnopril rx#161458369 to be missing fill date on Centrally Stored Medication log (CSML). R3 had bubble pack of Tramodol with no start date but 3 pills missing. Per caregiver, bubble pack arrived with resident upon move in, but has not taken any since admission, but no notes on CSML indicating as such. LPA advised that some note must be made to account for missing pills. R2 had prescription for Quetiapine in the amount of 300 mg daily (100mg in the morning and 200mg at night), LPA and caregiver observed a count of 50 remaining in the bottle with an original fill quantity of 90, start date was 6/28/2024 and fill date was 5/23/2024. Count was off, indicating missed doses. Caregiver explained that on 5/17/2024 and 6/24/2024 the prescribed dose was changed. LPA advised 5/17/24 is before fill date of 5/23/24, so prescription should have been changed before filling in order to ensure accurate fill, accurate dosing, and accurate entry on CSML (deficiency cited, see 809D). Continued on 809C(2)... Continued from 809C... Fikre Gurja Administrator certificate #7029598740 exp 1/7/2025 Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Current Lease Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. *Civil Penalty assessed* Appeal rights given and discussed with caregiver S2. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with caregiver S2 and a copy of this report was given.the state’s words, verbatim · CDSS document, Jul 18, 2024

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.