Sunshine Petaluma Care Home

Type of visit: Required - 1 Year

At approximately 11:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Licensee Roxana Galo and Administrator Diana White and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 2 residents. At approximately 11:45AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. 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. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen equipment was clean and in good repair. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required supply of perishable and non-perishable food. Hot water measured within regulation at faucets accessible to residents. Emergency water was present to ensure facility can be self-sufficient for 72 hours. Emergency lighting devices were present. First aid kit was present. No pools/bodies of water are on the premises. Facility has been conducting Emergency drills every 3 months. At approximately 12:15PM, LPA reviewed 4 of 4 resident files. 3 of 4 reappraisals were not conducted within the last 12 months. Documentation of a physician visit within the last 12 months was not present in 3 of 4 resident records. Medication records were organized and contained orders for each medication. Medications were secured in a locked cabinet. Continued on LIC809-C… At approximately 12:50PM, LPA reviewed staff files. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current. All employees requiring background checks are cleared. During this inspection, LPA observed the Licensee is working on changing one of the bedrooms of the facility. LPA provided technical guidance regarding the pathways for residents to use and to ensure residents do not have to pass through another residents room to exit. Licensee will submit updated facility sketch when completed. 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 LIC610E- Disaster Plan Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Diana White and Appeal rights were given.the state’s words, verbatim · CDSS document, Jul 21, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an inspection following a fire that occurred on 5/13/2026 and met with Administrator, Diana White. On 5/13/26 at approximately 4:44pm, the department received a call from an outside party reporting an electrical fire and facility was evacuated, followed by a facility incident report. According to incident report, on 5/13/26 there was an electrical fire around 4pm, the fire department was called immediately, they came out, inspected the source of the smoke/fire, where it was determined it was the refrigerator. The Fire Department unplugged the refrigerator and stated that it is nothing major, it only needs a small part replaced. Residents were evacuated to front of the house for approximately 30 minutes. However, Licensee decided to buy a whole new refrigerator. During today’s visit, LPA toured the facility premises to ensure that there is no fire damage in the property. Currently, the refrigerator was removed from the premises, damage was confined to the kitchen area and did not affect resident’s belongings. All responsible parties were notified. No deficiencies cited during today's visit. Exit interview conducted with Administrator and copy of this report was given.the state’s words, verbatim · CDSS document, May 20, 2026

Allegation investigated: Staff does not ensure that an adequate food supply is maintained on premises. Staff does not follow food menu for residents.

On 03/23/2026, at approximately 12:15 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct subsequent interviews and deliver complaint investigation findings regarding LIC802 - Complaint Report #21-AS-20260105122617, which was received by Community Care Licensing (CCL) on 01/05/2026 with the above listed allegations. LPA met with Roxanna Galo, Licensee. On 01/07/2026, LPA obtained documents, made observations, and conducted interviews. During the visit, LPA obtained a copy of the facility's sample menu and observed the facility's food supply which closely matched the meals listed on their sample menu. Both on 01/07/2026 and during today's inspection, LPA observed fresh fruit, vegetables, and protein as well as enough nonperishable food to sustain the residents in care for at least seven days as required per regulation. During both visits, LPA observed facility staff preparing fresh home cooked meals for residents in care. Continued on LIC9099C... Unsubstantiated Continued from LIC9099... Based on interviews conducted with Resident 1 (R1) and Resident 2 (R2) on 01/07/2026 and Resident 3 (R3) and Resident 4 (R4) today, all four residents reported being happy with the quality and quantity of the food served in the facility and report that facility makes dietary accommodations for them as needed. Based on interviews conducted, observations made, and records obtained, the allegations that staff does not follow food menu for residents and staff does not ensure that an adequate food supply is maintained on premises are 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 Licensee, whose signature on form confirms receipt of document(s).the state’s words, verbatim · CDSS document, Mar 23, 2026 · control 21-AS-20260105122617

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Cuadra conducted an unannounced case management inspection to following up on a self-reported incident submitted to Community Care Licensing and met with Roxana Galo, Licensee. The purpose of this case management inspection is to obtain additional information regarding incident involving resident (R1). LPA reviewed records and conducted interviews. Per incident report submitted 3/2/2026 reporting R1 had an un-witnessed fall on 2/26/2026. Licensee found R1 in the living room laying down at their left side R1 was bleeding from their head. At 5:00pm, R1’s responsible party arrived at the facility, helped them, checked them, decided not to call 911 and R1 remained in facility. During today’s visit, LPA reviewed R1's physician report dated 8/28/25 and care plan dated 11/22/25 which both do not indicate fall risk, but indicates that R1 had motor impairment left sided weakness due to a history of stroke. According to Licensee, the day of the incident, R1 sustained a small cut, triangle shape in their head, R1's responsible party arrived while the Licensee was assisting R1 after the un-witness fall happened, and R1's responsible party cut R1's hair near the area of the bleeding and applied vaseline, but they declined to call 911. R1's responsible party told the Licensee that they were taking responsibility and willing to sign any documentation certifying that they refused to take R1 to get medical assistance. As of today, R1's physician has not been contacted to notify them about R1's un-witnessed fall. LPA have a conversation with the Licensee about the requirement to follow up their facility plan of operation and regulation 87465 (a)(2) regarding providing medical assistance to a resident after a fall, hit head and bleeding observed. 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 with Licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Mar 6, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(2) · Plan of correction due date: Mar 13, 2026

87465 (a)(2) Incidental Medical and Dental Care - The licensee shall provide assistance in meeting necessary medical and dental needs...This requirement has not been met as evidenced by: Based on LPA's records review and interview with the Licensee, the facility failed to seek timely medical after R1 had an unwitnessed fall on 2/26/2026, as of today the unwitnessed fall hve not been reported to R1's physician for follow up, which is an immediate risk to the health and safety of the resident.the state’s words, verbatim · CDSS document, Mar 6, 2026

Plan of correction: Licensee agrees to contact R1's physician to report the incident and will submit self-certification that regulations 87465 Incidental Medical and Dental Care have been reviewed with facility staff and are understood to CCL by POC due date 3/13/2026.

Type of visit: Required - 1 Year

On 7/17/2025, Licensing Program Analyst (LPA) Hansen conducted an unannounced Annual inspection of this facility and was welcomed by Licensee Roxana Galo. This Residential Care Facility (RCFE) is single story with 4 bedrooms, has a fire clearance for 6 nonambulatory, currently provides care for six (6) residents two of which have a diagnosis of dementia and one receiving hospice services. Facility has an approved Hospice Waiver for 2. At approximately 11:25 AM LPA conducted tour of the facility with Licensee, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Hot water temperature measured between 111.7 degrees F and 113.9 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 2 resident’s bathrooms while touring facility. Bathrooms were equipped with necessary grab bars and slip-resistant mats, strips, or flooring were used in all bathtub and shower floors as required by Title 22 regulations. All bedrooms have lighting & appropriate furnishings per Title 22 regulations. There was a supply of hygiene products and paper products available for residents. Smoke detectors and carbon monoxide detectors were all found to be in working order. Medication and file storage is stored in a secured cabinet located in Administration area adjacent to kitchen. Working auditory alarms are placed on all exits. Toxins, cleaning supplies, and sharps were all found in locked cabinets inaccessible to residents in care. Continued on LIC 809-C Continued from LIC809: File Review began at 12:15 PM: A review of six residents & three staff records as well as two resident’s medications was conducted. LPA learned that 6 out of 6 residents have updated Appraisals as well as medical assessments. Review of staff records, staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions; In addition, Direct care staff have received the additional training requirements, LPA was also provided required proof of CPR & 1st Aid certification for all staff. Medication Audit began at 1:45 PM: Medications were centrally stored in locked cabinet in Admin area adjacent to kitchen. LPA reviewed medications of 2 out of 2 residents were found to be given according to physicians’ directions. Centrally Stored Medication Record (CSMR) of 2 out of the 2 residents reviewed medications were found to have all medications entered for residents. Disaster Drills have been conducted quarterly and in different shifts, with the last being conducted on 3/5/2025. Fire Extinguisher was found to be last serviced on 12/27/2024 at the time of the visit. LPA was informed by Licensee that Administrator Elia Cuevas has not worked at facility since May 2025 and has provided initial documentation for staff Angelica Lopez LVN to be changed to Administrator, also provided proof of submission of Administrator training. Will submit certificate when arrives. No citations given at today’s visit LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 8/7/2025: LIC 308 Designated (if changes) LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facility Resident’s Copy of Control of Property Lease-Deed Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Jul 17, 2025

Type of visit: Post Licensing

On 9/6/2024, Licensing Program Analyst (LPA) Hansen conducted an unannounced post licensing inspection for this facility and was welcomed by staff Magela who contacted by telephone Licensee Roxana Galo that arrived shortly after. Administrator Elia Cuevas was unable to attend. This RCFE facility with the capacity of 6 nonambulatory, currently provides care for two (2) residents one of which with a diagnosis of dementia and neither of which are receiving hospice services. Facility has an approved Hospice Waiver for 2. At approximately 8:35 AM LPA conducted tour of the facility with staff, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. The one Fire Extinguisher was found to be last serviced on 8/21/2023 at the time of the visit and reading is not showing fully charged (see TA LIC 9102). There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. When LPA entered facility at 8:30 AM observed (see pics) door with signal turned off and propped open from kitchen to garage where toxins and cleaning supplies are stored in cabinet in garage with locks that do not work as well as window cleaner in unlocked cabinet under kitchen sink all accessible to residents in care (see pics & LIC809-D). There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. LPA tested 6 smoke alarms and 2 carbon monoxide detector and were all found to be in working order. Medication and file storage is stored in a secured cabinet located in Administration area adjacent to the kitchen. Working auditory alarms are placed on all exits. Continued on LIC 809-C File Review began at 9:35 AM: A sample review of two residents & three staff records as well as two resident’s medications was conducted. LPA learned that 2 out of 2 residents have updated Appraisals as well as medical assessments. As per sample review of staff records, staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions; In addition, Direct care staff have received the additional training requirements although are not logged (see LIC9102 TA); LPA was also provided required proof of CPR & 1st Aid certification. Medication Audit began at 11:15 AM: Medications were centrally stored in locked cabinet in Admin area adjacent to kitchen. LPA observed medications of 2 out of 2 residents were found to be given according to physicians’ directions. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to have all medications entered for residents. LPA reviewed Licensing Information System (LIS) with Administrator who stated that is corrected and updated at this time; no need to change any of the information. Disaster Drills have not been conducted Technical Advisory given, although should be conducted quarterly and in different shifts. Facility has not obtained required Liability Insurance and is being cited today (see LIC809-D). Administrator Certificate for administrator Elia Cuevas # 6057784740 expires 1/4/2025. Appeal Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 6, 2024

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Cuadra arrived announced to conduct a Pre-licensing Subsequent Facility Inspection and met with Applicant Roxana Galo. A pre-licensing inspection was completed on 06/21/2024. During today’s visit LPA observed the following items: * Applicant obtained all required postings including the CCL Complaint Poster, Long Term Care Ombudsman Poster, Resident's Rights, and the rights to Resident and Family Councils. * Bedroom #1, #2 and #3 have chairs and dressers. * Bedroom #2: have a regular bed in room. * Bathroom located in bedroom #1 have non-skid mats placed in shower. * Administration area have a designated locked cabinet that will be used for medication and file storage. * Side deck area was cleaned. * Fire Clearance clarification was obtained indicating that the premises is able to be occupied by six non-ambulatory residents. Applicant agreed that no bedridden residents could be accepted and any variation to the fire clearance needs to be notified to the Department to have the fire department re-inspected and approved for any bedridden residents prior to acceptance. * Water heater is delivering temperature within 105-120 F degrees. Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulation. LPA will notify Application Unit Pre-licensing inspection is complete to proceed with the process of license. Pre-Licensing items needed to be repaired have been resolved. Pre-Licensing is now complete. No deficiencies cited at today’s inspection. Exit interview conducted with Applicant and a copy of this report was given.the state’s words, verbatim · CDSS document, Jul 2, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Cuadra arrived announced to conduct a pre-licensing inspection and was greeted by Applicant, Roxana Galo. Facility currently does not have residents in care. Once obtained, applicant will submit proof of required liability insurance. Facility has a Dementia Care Program. Per Applicant, they have submitted to the Application Unit a request for a hospice waiver for two residents, which is currently under review. The facility consists of a single story residence with a total of 3 bedrooms, 2 full bathrooms, administration office, laundry room located in the garage, kitchen, dining room, and living room as common areas. The facility received a fire clearance approval on 1/31/2024 by the Petaluma Fire Department for six [6] non-ambulatory residents in rooms# 1-3. According to applicant, the Fire Inspector mentioned that there are some rooms that could be used as a double room occupancy or bedridden residents. However, fire clearance effective 1/31/2024 did not clarify specific information on double room or bedridden capacity approval or which rooms are approved for bedridden use. LPA have notified analyst in the application unit and applicant to contact Fire Inspector to revise the fire clearance approval to clarify if one room could be used as a double room, bedridden capacity could be approved and which bedrooms could be approved for double room and bedridden. Two [2] fire extinguishers present and last serviced on August, 2023. Facility has a fire pull system. First aid kit present with all required items. Night lights in hallway present. Smoke and carbon monoxide detectors present and functioning. Working auditory alarms are placed on all exits. Administrator Certificate for administrator Celia Cuevas # 6057784740 expires 1/4/2025. Continued on LIC809C... Continued from LIC809... At approximately 1:00pm LPA/Applicant toured the building and grounds. The facility was found to be at a comfortable temperature. Bedroom #2 needs a regular bed instead of half rail bed currently in room. All resident rooms #1-3 needs additional furniture as stated per regulation with a chairs. Cleaning supplies will be stored in a secured cabinet located in the garage. Administration area located adjacent to the kitchen needs locked cabinet that will be used for medication and file storage. Side decks has debris that needs to be removed. Water temperatures read at: 90.5 and 88.9 degrees F which needs to be adjusted to 105-120 F degrees as stated per regulation. All bathrooms skid mats available need to be placed in shower. Items required to be repaired/addressed before licensure: * Applicant needs to obtain all required postings including the CCL Complaint Poster, Long Term Care Ombudsman Poster, Resident's Rights, and the rights to Resident and Family Councils. * Bedroom #1, #2 and #3 needs chair and dresser. * Bedroom #2: needs a regular bed instead of half rail bed currently in room. * Bathroom located in bedroom #1 needs non-skid mats available need to be placed in shower. * Administration area needs locked cabinet that will be used for medication and file storage. * Side deck area has debris that needs to be removed. * Fire Clearance clarification regarding double room occupancy and possible bedridden status. * Water heater needs to be adjusted to deliver temperature of 105-120 F degrees. Applicant agreed to notify Community Care Licensing once all repairs and personal accommodations are completed. LPA will conduct a subsequent visit to confirm required repairs had been completed. LPA will notify CAB analyst. LPA/Applicant reviewed and completed Component III orientation. Exit interview conducted with Applicant and a copy of this report given.the state’s words, verbatim · CDSS document, Jun 21, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Elia Cuevas, Administrator; Roxana Murillo, Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jun 11, 2024