Sleepy Hollow Assisted Living

Type of visit: Office

A Non-Compliance Conference (NCC) was conducted today in the Santa Rosa Regional Office. Present in the meeting were: Acting Regional Manager (ARM) Bethany Moellers, Licensing Program Manager (LPM) Victoria Bertozzi, Licensing Program Analysts (LPAs) Christi Coppo, Robert Frank and Licensees Lily Alcones and Arthur Alcones. The purpose of today's office meeting was to discuss areas of concern in the facility operation identified by the department and placing Sleepy Hollow Assisted Living, Hoen’s Care Home and Spring Creek Lodge on a Non-Compliance Conference (NCC) plan. Parties present during the meeting agreed to an NCC plan to bring the facilities into compliance. An Office meeting was held 9/15/2025 to discuss a change of ownership (CHOW) for all licensed facilities from a sole proprietorship to an LLC. An application for Spring Creek Lodge for a Change of Ownership was received on 10/15/2025, however, Licensee did not provide required payment or the incomplete documents that were requested in a letter sent by the Central Applications Bureau on 10/23/2025, so the Application was withdrawn. The department has not received a Change of Ownership application for Hoen’s Care Home or Sleepy Hollow Assisted Living to date. Parties present during the meeting agreed to an NCC plan for 2 years to bring the facility into compliance. Health and Safety Code 1569.686 Licensee notification of specified events; department initiation of compliance plan, noncompliance conference, or other appropriate action; penalties; exception was printed and given to licensee. Continued on 809-C... ...Continued from 809 The licensee understand that may not operate under their LLC as they are licensed under sole proprietorship There was a discussion about Technical Support Program (TSP) referral and Licensee agreed to be referred to the TSP program and referral will be submitted. Deficiencies are cited from the California Code of Regulations (CCR), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted with licensee and a copy of this report given.the state’s words, verbatim · CDSS document, Jul 22, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(2) · Plan of correction due date: Jul 24, 2026

Administrator - Qualifications and Duties 87405(d)(2) The administrator...If the licensee is also the administrator, all requirements for an administrator shall apply.(2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by: Licensee/Administrators not engaging in the CHOW process as directed in the 9/15/2025 Office meeting.the state’s words, verbatim · CDSS document, Jul 22, 2026

Plan of correction: Licensee to provide letter self-certifying that they will provide monthly updates on status of submitted application by plan of correction due date. This will be due every 22nd of the month. Facility to review Administrator qualifications and duties regulation and provide a monthly update on status of submitted application.

Type of visit: Office

An informal meeting was conducted today in the Santa Rosa Regional Office. Present at the meeting were Licensing Program Managers Bethany Moellers and Victoria Bertozzi (via Teams), Licensing Program Analysts Christi Coppo, Robert Frank, Marisol Cuadra (via Teams) and Licensee of the facility, Lily Alcones and Back up Administrator/Licensee Arthur Alcones. The purpose of the office meeting was to address areas of concern and discuss the change of ownership for Hoen’s Care Home # 496801205 and Spring Creek Lodge # 496803282 in which Lily Alcones is the identified licensee. Also, their sister facility Sleepy Hollow Assisted Living #496803576, in which Arthur Alcones is the identified licensee. On 9/10/25, LPAs learned about a change from individual to limited liability corporation (LLC). The areas of concern are reporting requirements and Administrator responsibilities and duties. The current options discussed during this office meeting are the following: -Licensee was not sure if she wants to keep facilities under the LLC or remove them from the LLC. CCL advised that licensee let CCL know their choice by no later 9/29/25. If they choose to keep the facilities in the LLC then licensee will need to submit a change of ownership application with new corporation or LLC to the Centralized Application Bureau (CAB) for the three facilities by no later than 10/13/25. CAB contact information was provided. - The Licensee agrees to review reporting requirements regulation (87211) and they will conduct all staff training to address ongoing reporting requirement issues by no later than 9/22/25. - Licensee stated that they do not plan to leave the country within the next 6 months and agreed to appoint a certified Administrator should they plan to be out of the country for an extended period of time. Continued on 809C... ...Continued from 809 Extended period of time is defined as anything longer than 30 days. CCL provided copy of regulation 87407 and 87405, for both Hoen’s Care Home # 496801205 and Spring Creek Lodge # 496803282. -LPAs offered TSP services to licensee. Licensee declined to participate. Deficiencies are cited from the California Code of Regulations (CCRs), Title 22, Division 6, Chapter 8 and the Health and Safety Code. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Appeal Rights Given. Exit interview conducted with Licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Sep 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87109(b) · Plan of correction due date: Oct 13, 2025

87109 Transferability of License (b)The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least thirty (30) days prior to the transfer of the property or business... This requirement is not met as evidenced by: Based on interview & record review, the licensee did not comply with the section cited above in the licensee did not notify Community Care Licensing within thirty (30) business days of the transfer of the facility to a Limited Liability Corporation which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 15, 2025

Plan of correction: Licensee to notify CCL regarding their choice to either remove facilities form LLC or keep them in the LLC by no later than 9/29/25. If they choose to keep in the LLC, licensee will provide proof to Community Care Licensing that an application has been submitted to the Centrailized Application Bureau by plan of correction due date of 10/13/2025.

Type of visit: Required - 1 Year

At approximately 8:30 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Caregiver (CG) John Manuit. Administrator Arthur Alcones arrived at 9:00 AM. Sleepy Hollow Assisted Living is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents, one (1) of whom can be bedridden. The facility has a Hospice Waiver for two (2) residents. Upon arrival, LPA was informed that there were four (4) residents in care and two (2) staff members on-site. At approximately 9:05 AM, 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 9:15 AM, LPA toured the facility with Administrator Alcones. All exits were clear and unobstructed. The facility's one (1) fire extinguisher was last serviced and tagged in December, 2024. The facility was sufficiently lighted. LPA inspected five (5) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills monthly. The last disaster drill was conducted on 7/15/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 10:00 AM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were observed to be well organized and thorough with all required documentation. LPA reviewed four (4) staff files. All staff files were observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for two (2) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Arthur Alcones’s Administrator Certification 7009494740 is current with an expiration date of 8/23/2026 . LPA requested the following documents be submitted to Community Care Licensing by 10/11/2025: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Proof of Liability Insurance The facility is in compliance. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Administrator Alcones. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 11, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility staff are not assisting resident with daily bathing Facility staff did not seek timely medical attention for the resident

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 4/22/25 at approximately 10:20:am, and met with Administrator Arthur Alcones. There were two caregivers on duty during the inspection. LPA observed that there was an agency staff providing one to one for a resident in care. Reporting party alleges that facility staff are not assisting resident with daily bathing, and facility staff did not seek timely medical attention for the resident. LPA reviewed resident, R1's, records and obtained copies that LPA requested, including medical documentation. The LPA interviewed staff and other related parties. The LPA toured the facility, observing resident rooms, bathrooms, and all common areas; The facility was observed to be clean and orderly. The investigation revealed that per interviews and record reviews, R1 has bathing as part of their care plan; R1 is bathed twice a week and as often as needed. Per records and interviews with staff, R1 is incontinent, R1is checked on every two hours, and cleaned and changed as needed. Staff deny that R1 had any skin injury and/or breakdown when checked last before going out per record reviews and medical records, on 2/8/25 R1 had eaten breakfast, and vomited, complaining they felt sick. Continued on LIC9099C... Unsubstantiated Staff contacted advice nurse regarding their observations of the resident being sick and vomiting, not able to eat. Advice nurse directed them to send resident out to the hospital by 911 to be seen by medical professional. R1 was admitted into the hospital for fecal impaction. R1 was noted in medical records to have a stage II pressure injury in progress notes documented from 2/12 through 2/14, 2025. There is no exact time and date of when R1 obtained the pressure injury per review of medical records and interviews. Staff deny resident had a pressure injury while in care at the facility. Wound care referral was made by the Doctor for R1, per discharge paperwork of 2/14/25. R1 was discharged back to the care facility. R1 had in-home-health wound care a few times a week; R1’s would has healed and R1’s last day of wound care was 3/25/25, per records. Per review of records, including care plans and staff interviews, R1 has a bathing schedule, twice a week and as often as needed. Per interviews with staff, and other related parties, it was revealed that resident R1 is said to be receiving bathing as needed and incontinent needs are being met. LPA observed R1 to be clean, and facility to be free from urine/feces/foul odors, including R1's room on both inspection dates of 2/18 and 4/22, 2025. There was no information obtained and/or observed by the LPA to support violations occurred regarding “facility staff are not assisting resident with daily bathing, and facility staff did not seek timely medical attention for the resident”. Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegations are Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies cited. Exit interview was conducted with the Lead Staff Lorena Lutynski. Report LIC9099 was left to Lorena Lutynski for the Administrator Arthur Alcones.the state’s words, verbatim · CDSS document, Apr 22, 2025 · control 21-AS-20250213160356

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Alviso and Contreras arrived unannounced to conduct a Case Management inspection, on 2/18/25 at approximately 10:00am, and met with Administrator Arthur Alcones. The purpose of the case management inspection is to cite observed deficiencies that are not related to the complaint inspection of earlier this am, 2/18/25. LPAs observed numerous over-the-counter medications on R2's side bed table in their room. Resident's medications are provided by staff assistance. Resident does not centrally store and/or handle own medications, per interviews. This deficiency will be cited, 87465(h)(1)(C )(2) Incidental Medical and Dental Care- Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility,Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication, see LIC809D. LPA obtained photos. LPAs observed a facility bathroom that is under renovations unlocked, making tools stored in the bathroom accessible to residents in care, and observed trip hazards, a lip of some tile fitted on the floor, and the hole in the floor where the toilet was removed. There is no door knob lock on the bathroom door leaving all accessible to residents in care. This deficiency will be cited, 87309(a)Storage Space and Access-Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage, see LIC809D. LPA obtained photos. Deficiencies 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 with Administrator/Licensee Arthur Alcones. Appeal Rights provided to the Administrator.the state’s words, verbatim · CDSS document, Feb 18, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(1)(C)(2) · Plan of correction due date: Feb 19, 2025

87465(h)(1)(C )(2) Incidental Medical and Dental Care- Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility,Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: LPAs observed numerous over-the-counter medications on R2's side bed table in their room. Resident's medications are provided by staff assistance. Resident does not centrally store and/or handle own medications, per interviews. This is a health & Safety risk to residents in care. LPA obtained photos.the state’s words, verbatim · CDSS document, Feb 18, 2025

Plan of correction: Licensee to ensure that all medications are centrally stored and inaccessible to residents in care. Hold an in--service medication training with all staff. Submit plan of correction by 2/19/25. Submit proof of training by 2/28/25.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Feb 19, 2025

87309(a)Storage Space and Access-Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by: LPAs observed a facility bathroom that is under renovations unlocked, making tools stored in the bathroom accessible to residents in care, and observed trip hazards, a lip of some tile fitted on the floor, and the hole in the floor where the toilet was removed. There is no door knob lock on the bathroom door leaving all accessible to residents in care. This is a health & safety risk to the residents in care. LPA obtained photos.the state’s words, verbatim · CDSS document, Feb 18, 2025

Plan of correction: Licensee to ensure the bathroom that is under renovation is kept locked and inaccessible to all residents in care at all times. Once the bathroom renovation is complete, it may be open to sue by residents in care. Submit plan of renovation estimated completion date, and plan of securing the bathroom, ensuring it is inaccessible. POC due 2/19/25.

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPAs) Alviso and Stevenson arrived unannounced to conduct a continued annual inspection, on 12/6/24 at approximately 11:05am, and was greeted by staff. Staff contacted Licensee/Administrator Arthur Alcones to notify them of the LPAs arrival. Administrator Arthur arrived to meet with the LPAs. Fire clearance approval for six (6) non-ambulatory, of which one (1) may be bedridden. The facility has a required infection control plan. The facility has a required emergency disaster plan as required. Facility has an approved dementia plan. The LPA toured the facility with staff. Hot water was measured at 120. degrees Fahrenheit, which is within regulation. Administrator will continue to ensure the hot water is within regulation, and not above 120.degrees and/or below 105 degrees Fahrenheit. There are three full bathrooms, and one 1/2/bathroom for residents use, but one of the full bathrooms is being renovated and is inaccessible at this time. Administrator to ensure the bathroom remains inaccessible to residents in care until renovation is complete. Administrator stated their understanding of the above. Bathrooms had grab bars and showers floor mats for resident use. The facility had sufficient lighting in all common areas, resident rooms, bathrooms, and hallways. Food supply was sufficient. All smoke alarms were working properly during the inspection; The facilities carbon monoxide detector was working properly during the inspection. Fire extinguisher, one (1), was being serviced and tagged during the inspection. Medications are kept in a small medication room that has a lock to keep medications locked and inaccessible to residents in care. LPAs reviewed five (5) resident files, including medication records. The LPAs reviewed four (4) staff files, including training. All staff had criminal record clearance as required. All staff had cpr and first aid certification as required. Continued on LIC809C... LPA is requesting the following documents be updated and submitted by 1/6/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Infection Control Plan (ensure to review and update as needed/required) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate. The following deficiencies were observed during the inspection and will be cited: LPAs' observed the staff room on the first floor unlocked, which had cigarettes, matches, and over the counter medications left accessible to residents in care. LPAs observed second floor staff room unlocked, which had numerous bottles of alcohol and disinfectants/cleaners left accessible to residents in care. This deficiency will be cited, 87705(f)(1)(2) Care of Persons with Dementia-The following shall be stored inaccessible to residents with dementia: Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants, see LIC809D. LPAs observed a hallway entry with the floor’s wooden transition strip with a large chunk missing which has created a health & safety hazard for potential to trip and/or fall.LPAs observed an outlet in a resident room is missing 87303 (a) Maintenance and Operation- The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors, see LIC809D. LPAs observed a resident’s room (R4’s) smells of urine odor; R4 is incontinent per review of records. This deficiency will be cited, 87625(b)(3) Managed Incontinence- In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence, see LIC809D. Continued on LIC809C... LPAs observed that the facility lacked an adequate emergency food supply as required by the health and safety code. This deficiency will be cited, 1569.695(a)(2) (a) In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage, see LIC809D. LPAs observed that the facility having complaint poster posted per regulation which poses/posed a potential health, safety or personal rights risk to persons in care.87468(c)(2)(A) Personal Rights- Licensees shall prominently post personal rights, nondiscrimination notice, & complaint information in areas accessible to residents, representatives, & the public. Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the RCFE Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website, see LIC809D. Deficiencies 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 with Administrator/Licensee Arthur Alcones. Appeal Rights provided to the Administrator.the state’s words, verbatim · CDSS document, Dec 6, 2024

Type of visit: Case Management - Other

At approximately 3:45PM, Licensing Program Analysts (LPA) LPA Loera and LPA Frank, arrived unannounced to conduct a Case Management - Other Visit and met with Licensee/Administrator, Arthur Alcones. The purpose of the visit is to confirm an Order to Individual for Immediate Exclusion for All Facilities. The Department delivered an "immediate exclusion" notice on 11/22/2024 to facility. Per notice, Staff Member 1 (S1) and Staff Member 2 (S2) cannot be allowed to work, be present and/or live in a CCL licensed facility, or have contact with residents in any residential facility or child day care licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 and S2 from any contact with residents and not allow these employees to be physically present in the facility. Licensee/Administrator informed LPA that S1 and S2 will be removed from the facility and from the facility's staff roster. Licensee/Administrator stated they understood the notice. No Deficiencies Cited during visit. Exit interview conducted. Copy of report and LIC811 (Confidential Names) discussed and provided to Licensee/Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Nov 22, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso arrived unannounced to conduct a Required- 1 Year inspection and was greeted by staff. Staff contacted Licensee/Administrator Arthur Alcones to notify them of the LPAs arrival. Administrator Arthur arrived to meet with the LPA. Fire clearance approval for six (6) non-ambulatory, of which one (1) may be bedridden. The facility has a required infection control plan. The facility has a required emergency disaster plan as required. Facility has an approved dementia plan. The LPA toured the facility with staff. All exits were observed to be clear and unobstructed. The facility has sufficient lighting in common areas and resident rooms. The LPA discussed some concerns of the flooring and rugs in the facility; Administrator stated to the LPA that they were having some of the rooms flooring changed out soon, and is also renovating the kitchen area soon. This annual will be completed by the LPA at a later date.the state’s words, verbatim · CDSS document, Oct 16, 2024