Spring Creek Lodge

Allegation investigated: Staff did not provide adequate supervision resulting in resident sustaining injuries. Staff did not respond to resident's call button in a timely manner.

Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced, to deliver findings on the above allegations. LPA met with caregiver. Licensee Lily Alcones was available by phone and gave caregiver permission to sign report. Complaint alleges staff did not provide adequate supervision resulting in resident sustaining injuries and staff did not respond to resident's call button in a timely manner. Complainant states that resident (R1) attempted to reach their suctioning cup from their bed, but was unable to do so. Complainant states that R1 rang the bell provided to alert staff; however, no one responded for approximately 15–20 minutes. R1 then allegedly crawled out of bed and fell, sustaining multiple skin tears in the process. Complainant states facility staff were present but did not respond quickly enough. During investigation LPA conducted interviews. Three (3) out of three (3) witnesses report that the Continued on 9099C... Unsubstantiated Continued from 9099... incident in question happened on the first day of R1’s residency at the facility. R1 was present at the facility for approximately one (1) hour before incident occurred. Three (3) out of three (3) witnesses report that facility staff were in R1’s room with a hospice nurse getting R1 set up with their room supplies and providing them a bell to call staff when needed. R1 subsequently had an evaluation by the hospice nurse. R1 then asked to speak to the hospice nurse privately. After speaking privately to R1, hospice nurse left R1’s room and went to facility kitchen to speak to facility staff. According to witness accounts, R1 was alone in their room for no more than 4-5 minutes. When hospice nurse went back into R1’s room that is when R1 was observed to be on the floor and bleeding from their elbows and knees. Three (3) out of three (3) witnesses report never hearing a call for help, any ringing of the bell, or any thud or loud noise coming from R1’s room. During investigation, LPA verified that bell can be heard from R1’s room from the kitchen. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Sep 16, 2026 · control 21-AS-20260724144114

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Lily Alcones, licensee. Facility currently has (4) residents in care one (1) of which are currently on hospice. At approximately 9:30am LPA and licensee 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 and labeled with opened dates present. LPA observed sharp knives locked. Cleaning products and laundry soaps are located in the garage and inaccessible to residents in care. 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 bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 128.6 degrees F in the kitchen and 130.5 in the bathroom used by residents, both of which are not within the allowable range of 105 to 120 degrees F. However, licensee had thermometer and showed LPA the reading on her thermometer which read 113 degrees F in the kitchen. LPA advised to get a new thermometer and try testing with that. LPA is not issuing a citation due to discrepancy in thermometer readings. Licensee will get a new thermometer and test again, and adjusting water heater temperature as needed. Fire extinguishers were last inspected 11/6/25. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted on 4/27/26. Facility has a backup generator for use during a power outage. Continued on 809C... Continued from 809... Lily Alcones Administrator Certificate 7003673740 expired 2/27/26; however, certificate is currently in Renewal-Pending status. At approximately 11:00am LPA conducted a review of four (4) out of four (4) resident files and two (2) out of (2) staff records. LPA printed Health and Safety Code regulations 1569.69 and 1569.696, pertaining to staff medication training and the required subject matter training for postural supports, restricted conditions, and hospice care. LPA advised of subject matters required for medication training. At approximately 12:00pm LPA conducted review of medication and medication records. LPA reminded licensee that pre-pouring is not allowed. LPA went over PRNs and PRN MAR requirements. LPA also reviewed Emergency Disaster Plan (LIC610E). Licensee confirmed no updates. No deficiencies cited during this inspection. 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 Exit interview conducted with licensee and a copy of this report given.the state’s words, verbatim · CDSS document, Aug 3, 2026

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 (RM) 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. 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 29, 2026

Administrator - Qualifications and Duties 87405(d)(2) 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. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This regulation was not met as evidenced by Licensee/Administrators not engaging in the CHOW process as directed in the 9/15/2025 Office meetingthe state’s words, verbatim · CDSS document, Jul 22, 2026

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 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. Extended Continued on 809... Continued from 809... 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 refused participation. 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: Sep 29, 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 from LLC or keep them in the LLC by no later than plan of correction due date 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: POC

Licensing Program Analyst (LPA) Cuadra conducted an unannounced case management inspection of this licensed senior care facility and met with Administrator Lily Alcones. The purpose of this case management inspection is to follow up on uncleared deficiencies cited during annual visit conducted on 8/14/2025. As of today's inspection citations 87303 (a) with POC date extended to 8/20/25, 87303 (e)(3) with POC date extended to 8/20/25, 1569.269(a)(1) with POC date 8/22/25 and 87156(b)(1)(F) with POC date 8/22/25 are outstanding. On 8/15/25, Back up Administrator submitted an extension request of POC due date, which it was granted by LPA. On 8/20/25, back up administrator submitted an unlawful appeal request, where it was requested by LPM Bertozzi to clarify by providing supporting documentation for their appeal as well as submitting requested written plans and an explanation of why the citation should not have been issued to continue the appeal process. However, as of today CCL have not received any of the documentation requested to clear the outstanding deficiencies. During today's visit, Administrator provided proof of correction for citations 87303 (e)(3). Deficiency cleared from annual inspection 8/14/2025. Administrator could not provide proof of to clear citation: -87303(a) - Facility to submit requested written plan prior to start the expected construction on September 14, 2025, the written plan should address how the facility will ensure the health and safety of residents in care while the construction occurs, as well as materials and equipment handling inaccessible to residents in care. Staff will be required to continuously remind and check all residents to make sure that they are not going to the construction site and notify their responsible parties. Continue on LIC809C... Continued from LIC809... - 1569.269(a)(1) - The facility will conduct all staff training regarding personal rights. Training subject, date of training and signed attendance forms to be submitted to CCL by POC due date. - 87156(b)(1)(F) - The licensee paid the annual fees, but they did not submit in writing a plan how they shall ensure moving forward the annual fees are paid by the annual due date. During last annual visit, LPA requested back up Administrator, Arthur Alcones to submit a written plan from Licensee to address how they will ensure that back up administrator spends a reasonable amount of time in the facility, while Licensee/Administrator Lily Alcones is away for a long period of time from the facility to ensure resident's care needs will be met in case of an emergency and Community Care Licensing inspections. Today, Administrator agreed to submit requested written plan regarding timely response to come to the facility to ensure resident's care needs will be met in case of an emergency and Community Care Licensing inspections. LPA issued citation with new POC dates. Exit interview conducted with Administrator. 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.the state’s words, verbatim · CDSS document, Aug 28, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(1) · Plan of correction due date: Sep 5, 2025

§1569.269 Enumerated rights; severability (a) Residents of RCFE shall have all of the following rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other people. This requirement has not been met as evidence by: Based on LPA’s/staff observations during abbual visit conducted on 8/14/25, the facility staff assisted residents in care using inappropriate comments by referring to them as "this one", which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: Administrator could not provide proof of training to clear citation. The facility will conduct all staff training regarding personal rights. Training subject, date of training and signed attendance forms to be submitted to CCL by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Sep 5, 2025

(a) 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. This requirement is not met as evidenced by: Based on LPA/staff during abbual visit conducted on 8/14/25, facility failed to submit requested written plan regarding construction project about how the facility will ensure the residents’ safety and personal rights, which poses a potential ealth, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: Facility to submit requested written plan prior to start the expected construction on 9/14/25, addressing how the facility will ensure the health & safety of residents in care while the construction occurs, as well as materials, equipment handling, and notifying their responsible parties.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87156(b)(1)(F) · Plan of correction due date: Sep 5, 2025

87156 (b)(1)(F) Licensing Fees. In addition to fee set forth in subdivision , the department shall charge the following.. licensee fails to pay the annual licensing fee on or before the due date as indicated by postmark on the payment. This requirement is not met as evidenced by: Based on record review, during abbual visit conducted on 8/14/25, the licensee did not comply with the section cited above in paying the annual fee in the amount of $495, but did not submitted written plan, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: The licensee paid the annual fee, but did not submit in writing a plan how they shall ensure moving forward the annual fees are paid by the annual due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a required Annual inspection and was greeted by caregiver Edwin Taitano. Administrator Lily Alcones was in the Phillipines and staff called back up Administrator, Arthur Alcones to come to the facility. However, Mr. Alcones arrived at 10:17am. LPA requested a written plan from Licensee to address how they will ensure that back up administrator spends a reasonable amount of time in the facility, while Licensee/Administrator Lily Alcones is in the Phillipines to ensure resident's care needs will be met in case of an emergency and Community Care Licensing inspections. Facility contact information was reviewed. Annual fees are outstanding in the amount of $495. At approximately 9:00am LPA toured the building and grounds. The facility was found to be at a comfortable temperature. All bedrooms were equipped with required furniture. Fire extinguisher charged and serviced as of December 2024. Smoke detectors and carbon monoxide were tested and operational. Auditory alarms were found operational. Last disaster drill was conducted on 7/8/25. Extra hygiene products and linens were available. LPA observed at least a two day supply of perishable and seven day supply of non-perishable food. Kitchen drawer with sharp knives locked. Cabinets containing cleaning supplies locked. Resident's bathrooms had required bath mat and grab bar, but one out of two bathrooms did not have paper towels available for residents in care (technical advisory issued). At approximately 9:05am, LPA/staff observed a lock in the exit gate, during last annual conducted on 8/14/24, LPA reviewed fire clearance facility sketch and it was clarified with back up administrator to be an exit gate identified as an emergency exit. LPA have a conversation with back up administrator to remind them of this exit is identified as a fire clearance exit, and it must offer access for residents as an escape in emergency situations, the lock was removed by back up administrator. Continued on 809C... Continued from 809... Also, it was observed in resident's rooms cracks on the wall that needed to be repaired. Back up administrator showed LPA written communication with LPM Bertozzi dated June 2025 outlining their intentions to start a construction project where adobe clay of the foundation is settle causing the cracks on the walls. According to back up administrator, they are fully permitted to start the construction from the city of Santa Rosa to raise the foundation on the right side of the house by 4 to 6 inches, which according to the contractor it will be completely safe for the residents to stay in their rooms without a need to relocation. However, as described per the drill down will be around 20 feet and LPA has concerns of potential disruption due to noise that this project could cause to residents in care. LPA requested written plan to be submitted to CCL prior to start the expected construction September 14, 2025 along with copy of building permit from the City of Santa Rosa. The written plan should address how the facility will ensure the health and safety of residents in care while the construction occurs, as well as materials and equipment handling inaccessible to residents in care. Staff will be required to continuously remind and check all residents to make sure that they are not going to the construction site and notify their responsible parties. During tour of the facility, LPA inquired with staff regarding bed rails documentation been posted on the walls of resident's rooms. Upon inquire with staff (S1) who entered the room made an inappropriate comment to R1, by referring to them as "this one" and R1 stare at them. LPA raised the concern about staff needs to be respectful with resident's personal rights to back up administrator who addressed with S1 this incident. At approximately 9:10am, LPA/staff measured water temperature in faucets used by residents 129.2 and 126.5, which is not within the allowable range of 105 to 120 degrees F. Back up administrator adjusted water heater. **Civil Penalty assessed in total amount of $250.00 for repeated violation within 12 months. At approximately 9:15am LPA/staff observed a bag of ten carrots sitting on the kitchen counter it was spoiled and 18 cans of thick and easy were expired as of 1/31/25. Food was not been stored in a safe manner as indicated by regulation. Food was discarded by staff. During LPA's visit, there were no activities to be conducted with residents in care. LPA had a conversation with back up administrator who stated that residents are not engaged in any of the activities been offered. LPA suggested to review current activity calendar and update it to offer more engaging activities (technical violation issued). Continued on LIC809C... Continued from LIC809C... At approximately 9:20am, LPA/staff attempted to flush the toilet in the bathroom across from room number six and it was not working. Electric face plate located in the kitchen is broken and it needs to be replaced, During last annual visit conducted on 8/14/24, LPA cited fence in backyard needed to be repaired, handrails broken and base of handrails cracked. There was a frame of wood with nails exposed. Per back up Administrator it was agreed to be repaired, but it wasn't fully repaired. **Civil Penalty assessed in total amount of $250.00 for repeated violation within 12 months. LPA initiated file review at 10:00 am. LPA reviewed four residents files and three staff files. One out of four residents (R2) needs medical assessment to be updated and it was requested to their physician on 7/15/25 and facility is waiting on their response (technical violation issued). Resident's needs service plans are updated. The facility has implemented a computerized system to update resident's care plans and is maintained in the facility computer for accessibility. LPA/back up administrator discussed Dementia regulation changes including focus on person-centered care and provided resources including LIC602A form for their review. All three out of three staff do have current First Aid/CPR certificates and 20 hours of additional required training. Administrator Certificate for Lily Alcones, 7003673740, expires on 3/9/2026. Medications and medication records were reviewed. 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 and 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 Licensee. **Civil Penalties assessed in total amount of $250.00 each for repeated violation within 12 months. Exit interview conducted with Back up Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Aug 14, 2025

The state marks this report as 10 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Christi Coppo and Marisol Cuadra arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Administrator Lily Alcones arrived later. Facility contact information was reviewed. At approximately 9:15am LPAs toured the building and grounds. The facility was found to be at a comfortable temperature. LPAs 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. Cabinets containing cleaning supplies locked. 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 temperature in sink accessible to residents in care measured at 158 degrees F in the kitchen, LPA could not get a hot water reading in the bathroom across from room six, the water never got hot after running the water for 4 minutes which is not within the allowable range of 105 to 120 degrees F (deficiency cited, see 809D). LPAs observed window in back bathroom in hallway to be broken, does not stay up when lifted, will not stay open. LPAs observed hole in wall on left side of the refrigerator. Backyard deck in disrepair, handrails broken and base of handrails cracked. Fence in backyard also in disrepair. Planks separated from fence with nails exposed. Large fence surrounding the perimeter of the facility is also in disrepair, boards separating from fence and nails exposed. Vents on side of house have gaps and black film substance. Per LPAs conversation with Admin they agree to repair. LPAs reviewed fire clearance facility sketch and observed exit gate to be identified as an emergency exit. LPAs observed exit gate to be broken, does not close or open all the way. However, because this is identified as a fire clearance exit, it must offer access for residents as an escape in emergency situations.(deficiency cited, see 809D). Continued on 809C... Continued from 809... LPAs discussed with Admin deck and kitchen, Admin indicated that they will be redoing the deck and remodeling the kitchen, but not changing the structure of the facility. LPAs advised that if they do change the structure of the facility they must obtain the proper and required permits first and give notice to CCL prior to any initiation of construction. Fire extinguishers were last inspected 9/15/2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted on 6/27/2024. Facility has a backup generator for use during a power outage. At approximately 10:30am LPAs conducted review of 5 staff records. All required documentation present. Admin indicated they have three full time staff, one of which is staff (S1). However, (S1) did not have fingerprint clearance and not associated to the facility, but per Admin has been working here for about 3 months (deficiency cited, see 809D and civil penalty assessed in the amount of $500 LIC421BG). At approximately 11:30am LPAs conducted a review of 6 resident records. Resident (R1) is indicated as bedridden on their physician's report. However, facility does not have fire clearance for bedridden residents. Admin unable to produce proof of notification to the Santa Rosa Fire Dept. LPAs and Admin discussed bedridden status on current physician's report, due to two different status being marked, Admin agreed to get updated physician's report clarifying ambulatory status of resident R1 (deficiency cited, see 809D). At approximately 12:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies Lily Alcones Administrator Certificate 7003673740 expires 8/31/2024. All fees are current as of this time. LPAs and Administrator discussed facility's Infection Control Plan and Emergency Disaster plan. No new updates. Continued on 809C(2)... Continued from 809C... 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 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. Exit interview conducted with Administrator and a copy of this report was giventhe state’s words, verbatim · CDSS document, Aug 15, 2024