Shiloh Green Manor of Santa Rosa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year inspection, at about 1:55pm on 3/10/26, and met with Administrator Manuel Ortega. LPA observed three care staff, S3, S4,and S5, on duty upon their arrival; The staff contacted the Administrator Manuel to notify them of the LPA's arrival. Currently there are six (6)residents in care. Facility has a dementia plan of operation. There is an approved hospice waiver for four (4) residents. Fire clearance is approved for six (6) non-ambulatory, of which one may be bedridden (RM #6.) Facility has a required infection control plan. Fire extinguishers, two (3), were serviced and tagged as required. Facility has a required emergency disaster plan. . LPA reviewed six (6) resident files. All files were complete, including medication records. All medications were locked up and centrally stored, as required. LPA reviewed four (4) staff files. All staff had criminal record clearance as required. All staff have first aid certification and CPR certification. Facility had sufficient lighting in bathrooms, resident rooms, hallways, and all common areas for residents in care. The home was at a comfortable temperature during the inspection. The food supply was observed to be sufficient, in perishables and non-perishables. The facility was clean and orderly. Bathrooms had grab bars, and non-slip mats/flooring in showers for resident use. Facility had sufficient furnishings for residents' use. Facility hot water was measured at 114.8 degrees Fahrenheit. Backyard was clean and orderly, with patio/yard furnishing for resident use as wanted. Continued on LIC809C... LPA is requesting the following documents be updated and submitted by 4/10/26: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required-no changes submit copy of review page) If changes submit plan copy Infection Control Plan (ensure to review and update as needed/required- no changes submit copy of review page)- If changes submit plan copy LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Current Liability Insurance Resident Roster Copy of current Administrator Certificate The following deficiency was observed by the LPA during the inspection: Upon LPA's arrival to the facility, while standing at the front door, the LPA heard a staff speaking to a resident in an inappropriate manner, speaking in a very loud irritated voice at the resident. LPA questioned staff once inside the home. In summary, staff S3 stated that they were speaking with resident R1. S3 stated that the resident was trying to go outside of the front door and this is why they were speaking that way. LPA stated they were speaking so loud and irritated at the resident, and S3 stated that it was because the resident was trying to leave that's why. LPA discussed personal rights of residents in care with the staff. Resident R1 needs redirection by staff and/or the staff to follow the resident out and redirect them back inside the facility. Staff are not to raise their voice at the resident and/or yell at them. This deficiency will be cited, 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities-In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs, see LIC809D. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited: Failure to correct deficiencies as required may result in civil penalties being assessed. Exit interview conducted with the Administrator Manuel Ortega. Appeal Rights provided with LIC809 report.the state’s words, verbatim · CDSS document, Mar 10, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPA) Alviso conducted a continued annual inspection, at about 9:00am on 4/14/25, and met with Manuel Ortega. The annual was started on 2/24/25, see LIC809. Facility has an approved dementia plan of operation. There is an approved hospice waiver for four (4) residents. Fire clearance is approved for six (6) non-ambulatory, which includes one bedridden clearance (RM #6.) Fire extinguishers, two (3), were serviced and tagged as required. Facility has a required emergency disaster plan. Facility has a required infection control plan. Per review of emergency disaster drills, they are being conducted as required. Last drills conducted were 4/10/25 fire drill and 12/2/24 earthquake drill. Currently there are five (5)residents in care. LPA reviewed five (5) resident files. All resident files were complete. LPA reviewed resident medication records. LPA reviewed five (5) staff files. All staff had criminal record clearance. All staff had required training. All staff had first aid certification and CPR certification. Staff files were complete. LPA is requesting the following documents be updated and submitted to CCL by 5/14//2025: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610 - Emergency Disaster Plan-update if needed-submit if changes Copy of Current Liability Insurance Copy of current Administrator Certificate Copy of updated Infection Control Plan- update if needed- submit if changes There are no deficiencies cited today. Exit interview was conducted with Manuel Ortega, Administrator.the state’s words, verbatim · CDSS document, Apr 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Alviso and Contreras conducted a Required- 1 Year inspection, at about 3:40pm on 2/24/25, and met with Manuel and Joy Ortega. Currently there are six (6)residents in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for four (4) residents. Fire clearance is approved for six (6) non-ambulatory, which includes one bedridden clearance (RM #6.) Fire extinguishers, two (3), were serviced and tagged as required. Facility has a required emergency disaster plan. Facility has a required infection control plan. The LPAs toured the facility with Licensee Joy and Manuel. Hot water was checked at 109.2 degrees Fahrenheit. All medications were locked up and inaccessible to residents in care, and staff/others that don't handle resident medications. All disinfectants/cleaners were locked up and inaccessible to residents in care. Facility had a sufficient supply of emergency supplies, including food and water, to meet the 72-hour shelter in place requirements. Carbon monoxide detector was working properly during the inspection. All exit doors had auditory alarms on them; All auditory alarms were working properly. This annual will be continued by the LPAs at a later date.the state’s words, verbatim · CDSS document, Feb 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso, conducted a Required- 1 Year inspection, at about 2:05pm on 2/29/24, and met with Barbara Santos, caregiver. Caregiver contacted the Licensees/Administrators Joy and Manuel Ortega, who arrived a short time later. The facility has six (6) residents in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for four (4) residents. Fire clearance is approved for six (6) non-ambulatory, which includes one bedridden clearance (RM #6.) Fire extinguishers, two (3), were serviced and tagged as required, expires 12/6/24. Facility has a required emergency disaster plan. Facility has a required infection control plan. LPA reviewed six (6) resident files; All resident files were complete. LPA reviewed six (6) staff files. All staff have criminal record clearance as required. All staff had current First Aid and CPR as required. All staff had required annual training completed. LPA toured the facility with the Administrator. The home was clean and orderly. Hot water was checked at 111. degrees Fahrenheit All exits were clear. All common areas, hallways, bathrooms, and resident rooms had sufficient lighting for resident use. Facility had a sufficient supply of perishable and nonperishable food. Facility had a sufficient supply of hygiene products, paper products, and cleaning supplies. Medications were locked and inaccessible to residents in care. Toxins were locked and inaccessible to residents in care. Bathrooms had grab bars and non-slip mat for resident use. The facility has supplies to meet the 72 hour shelter in place requirement. Continued on LIC809C... LPA is requesting the following documents be updated and submitted by 3/27/24: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan- review and submit (provide all information in all boxes as required) Infection Control Plan- review and submit (provide all information as required) Copy of LIC400 Handling of Client Cash Resources (complete the form even if not handling cash) Copy of required Surety Bond (if handling cash) Copy of Current required Liability Insurance Copy of current Administrator Certificate There are no deficiencies cited during today's inspection.the state’s words, verbatim · CDSS document, Feb 29, 2024