Valley View Care Home

Type of visit: Office

A Non-Compliance Conference (NCC) was conducted today in the Santa Rosa Regional Office. Present in the meeting were: Regional Manager (RM) Carla Nuti-Martinez, Licensing Program Manager (LPM) Victoria Bertozzi, Licensing Program Analysts (LPAs) Christi Coppo, Marisol Cuadra and Licensee Josephine Credo. The purpose of today's office meeting was to discuss areas of concern in the facility operation identified by the department and placing Valley View Care Home, Five Palms Care Home and Chanate Care Home 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 for all licensed facilities from a sole proprietorship to an LLC. To date, the Change of Ownership is delayed due to not having a valid LLC. Items addressed during the meeting include, but are not limited to: Significant Delay in bringing LLC into compliance therefore delaying the Change in Ownership Recent findings by the Department of Labor Medication Management Record keeping (Administrator) 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, Jun 10, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Jun 17, 2026

87405 Administrator - Qualifications and Duties. (a) All facilities shall have a qualified and currently certified administrator. This requirement is not met as evidenced by: Based on LPAs'/licensee observation, interviews and record review, the licensee did not comply with the section cited above in not maintaining required facility documentation updated, which poses a potential risk to the health, safety, or personal rights to persons in care.the state’s words, verbatim · CDSS document, Jun 10, 2026

Plan of correction: The licensee agrees to submit written plan agreeing to comply with administrator qualifications including accountable staff that will be responsible of mantaining facility documentation and medication updated to clear the citation by POC due date of 6/17/2026.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Licensee Josephine Credo. Facility currently has three (3) residents, two (2) of which are on hospice. At approximately 9:30am LPA toured the building and grounds. 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 most were labeled. Cleaning supplies were locked in the laundry room. Kitchen drawer with sharp knives 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 112.3 degrees F which is within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 2/16/26. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted last conducted 3/28/26. Facility has a backup generator for use during a power outage. Facility has large pile, approximately 4 feet tall, of dried leaves, branches, and elements of tree that was cut down. Per licensee, tree was just cut down this weekend and all brush will be removed by 6/11/26. At approximately 11:30am LPA initiated file review. LPA conducted a review of three (3) resident records. Resident (R1) in room #2 is bedridden and on hospice. However, licensee could not show documentation of notification to fire department (deficiency cited, see 809D). Resident (R2) did not have TB clearance on file. Continued on 809C... Continued from 809... R2's 2022 physician's report indicates a PPD test was completed but noted the results are attached on a separate report. Licensee could not produce report showing clearance. The "no evidence of communicable disease" box was checked in ink but did not have a date or any results. R2 also did not have a current physician's report on file, the most current was dated 3/6/25. However, licensee produced an email from R2's hospice nurse stating they and licensee filled out the physician's report and emailed doctor asking doctor to sign it. LPA observed report to be signed and dated with today's date, sent at 11:02am. LPA advised licensee to obtain copy of report with findings as the doctor's notation indicates. LPA reviewed hospice care plans for all residents on hospice. LPA and licensee discussed ensuring physician reports are completed annually. Two (2) out of three (3) residents require use of a hoyer, one of which requires two people to manage incontinence care. However, licensee staffs one person at night. This staff is live-in and is sleeping. At approximately 1:30pm LPA conducted review of three [3] staff records. Staff (S1) has not been employed at the facility for longer than 12 months, but has only completed eleven (11) hours of the required twelve (12) hours of dementia care training. LPA discussed with licensee ensuring all hours are completed. Facility emplys three (3) staff; two of which completed shadowing training with the newest staff. LPA discussed qualifications required of those conducting training per Health and Safety Code 1569.69 At approximately 2:30pm LPA, caregiver, and licensee conducted a spot check of medication and medication records. Resident (R3) had Docusate Sodium 100mg and Senna 8.6mg medications but there was not a corresponding signed doctor's order on file. R2 had current doctor's orders on file as part of hospice care plan. Discrepancies were identified as to dosing hours and mg/ml of medications. Medication with discrepancies include morphine, lorazapam, haloperidol, and acetaminophen. Medications have not been started yet as they are comfort medications. Licensee will immediately contact pharmacy and hospice prescriber to clarify discrepancies. Additionally, medication counts off by one tablet for all of R2's medications as facility is prepouring for the day. Licensee and caregiver claim LPA advised last year that they could prepour for the day, only. LPA advised of regulation 87465(h)(5). Licensee and caregiver confirmed Continued on 809C(2)... Continued from 809C... they understand facility must cease prepouring medications. 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 licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Jun 4, 2026

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.

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 Microsoft Teams), Licensing Program Analysts Christi Coppo, Robert Frank, Marisol Cuadra (via Microsoft Teams) and Licensee of the facility, Josephine Credo. On 9/10/25, The Licensee submitted written communication via email to the Department requesting information regarding change of ownership. Currently, LIC309 Administrative Organization form indicates that these facilities are in a sole proprietorship. According to the Licensee, their accountant has advised them to switch it to a limited liability company (LLC) where Josephine Credo will be the Licensee in LLC of these facilities. The purpose of the office meeting was to address concerns and discuss the change of ownership for Five Palms Care Home #496803300, Valley View Care Home #496803362 and Chanate Care Home #496801588 in which Josephine Credo is the identified Licensee to date a new application has not been submitted to the Department. License acknowledges that they are responsible for the operation until the new application is approved and issued. The Licensee agrees to provide documentation to ensure control of property. The Licensee confirms understanding that the current license is not transferable and an application is required to be submitted to the Department for change of ownership. Also, areas of concern regarding training materials that are not updated and reporting requirements. The current options discussed during today’s office meeting are the following: -Licensee confirmed that facility is operating under new J&J Assisted Living, LLC. The LLC was filed in 2019. Licensee advised LegalZoom was not able to submit 2020 and 2021 Statement of Facts which is the explanation licensee gave for being suspended with the Franchise Tax Board (FTB). LPM Moellers advised this must be cleared up Continued on 809C... Continued from 809... before proceeding with Centralized Application Bureau (CAB). LPM Bertozzi advised to update their Plan of Operation. To be included in the new Plan of Operation licensee will need to reference what training will be provided to staff. 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. -LPAs reviewed reporting requirements regulation (87211), and gave copy to LLC. -The Licensee agrees to submit current training materials and a plan of how she will utilize the new vendor for staff training. Licensee to submit course contents from new training vendor, by no later than 9/22/25. -LPM Moellers offered TSP, licensee agreed 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 giventhe 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 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

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Licensee Josephine Credo. At approximately 1:45pm 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 and most were labeled. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. 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 bar. Water temperature in sink accessible to residents in care measured at 109.7 degrees F which is within the allowable range of 105 to 120 degrees F. Residents in rooms #3 and #6 have oxygen in use but licensee could not produce notification fax to fire dept (deficiency cited, see 809D). Additionally, rooms #3 and #6 do not have oxygen in use sign present (deficiency cited, see 809D). Fire extinguishers were last inspected 2/14/25. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted last conducted 4/19/24 (deficiency cited, see 809D). Facility has a backup generator for use during a power outage. At approximately 3:30pm LPA conducted a review of 6 resident records. Residents R1 and R2 have Continued on 809C... Continued from 809... Appraisal Needs and Services plans dated 5/31/22 and 6/13/22, respectively (deficiency cited, see 809D). This deficiency was cited at facility's last annual inspection and re-cited for failure to correct on 7/19/24. However due to regulation changes, the regulation is now 87463(a), it is no longer 87463(c), so LPA unable to assess civil penalty for repeat violation At approximately 2:30pm LPA conducted review of four [4] staff records. S1 is not associated to the facility nor do they have fingerprint clearance. LPA verified fingerprint status on Guardian website. S1 has entry on Guardian with a determination status of closed incomplete application, closed on 12/2/24 with a status date of 3/2/25. LPA printed letter sent to applicant for licensee (deficiency cited, see 809D and civil penalty assessed.) Additionally, per licensee and S1, S1 had just moved their belongings into the trailer on the side of the facility. LPA advised that S1 cannot reside in trailer until fingerprint clearance granted. Staff S1 and S3 did not have any training, any 1st Aid/CPR certification or a Health Screen on file (deficiencies cited, see 809D and civil penalties assessed for repeat violations within a 12 month period). Staff S2 last training completed 2/23/22 and 1st Aid/CPR expired 1/16/24. Staff S4 last training completed 5/12/24 and 1st Aid/CPR expired 11/18/2018 (deficiencies cited, see 809D). At approximately 4:45pm LPA and licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. 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 licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Jun 3, 2025

Type of visit: Case Management - Other

At approximately 2:50pm Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a Case Management and was greeted by caregiver. Licensee Josephine Credo contacted by phone and gave caregiver permission to sign report. LPA advised Admin of the nature of the visit as being to re-cited for outstanding deficiencies. Facility currently has 6 residents in care, one of which is on hospice, which is allowable per the facility's Hospice Waiver. On 5/22/2024 LPA conducted the required annual inspection for this facility. The inspection resulted in 9 citations for the following respective deficiencies: HSC1569.618(c)(3), 87303(a), 87303(e)(5), 87463(c), 87705(c)(5), 87405(a), 87412(a)(11), 87465(a)(4), and 87412(c). Each deficiency had its own respective plan of correction due date. The plans of correction for deficiencies HSC1569.618(c)(3), 87303(a), and 87303(e)(5) have been fulfilled. However, the plans of correction for the deficiencies (87463(c), 87705(c)(5), 87405(a), 87412(a)(11), 87465(a)(4), and 87412(c)) are still outstanding. On 5/23/2024 licensee emailed LPA to ask for an extension on plan of correction due dates. LPA granted the extension request and advised the following: Please do not worry about the plans due in order to satisfy the plan of correction due date today. Please submit them by Tuesday, 5/28/24. And, remember that only the plan to get the staff 1st Aid/CPR certified is due, not the actual certifications. The actual certifications are not due until 6/5/24. Same goes for the medication training. Only the plan was due today (now due 5/28/2024) and the actual training does not have to be completed until 6/12/2024. On 6/11/2024 licensee emailed LPA to ask for another plan of correction due date extension, LPA once again granted an extension and advised via email: In regard to the currently past due plans of correction, CCL is extending the due date to this Friday, 6/14/24 in order for you to gather all the necessary items and submit them. Continued on 809C... Continued from 809... CCL granted licensee plan of correction due date extensions on two different occasions. However, the plans of correction for deficiencies 87463(c), 87705(c)(5), 87405(a), 87412(a)(11), 87465(a)(4), and 87412(c)) are still outstanding. Therefore, the deficiencies issued on 5/22/2024 that remain outstanding are being re-cited (deficiencies cited, see 809Ds). 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 caregiver. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with caregiver and a copy of this report was given.the state’s words, verbatim · CDSS document, Jul 19, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a) · Plan of correction due date: Jul 22, 2024

87465 (a)(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that LPA and Admin observed medication errors during spot check of R2s medication: Vitamin B12 bubble pack with start date of 5/15/2024 had one tablet missing. Levothyroxine with start date of 5/15/2024 had one tablet missing which poses an immediate health, safety or personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Jul 19, 2024

Plan of correction: Facility to submit plan to train staff on how to properly administer medication to residents by plan of correction due date of 7/22/2024. Training materials to be submitted to CCL for approval. Training logs to contain name of trainer, (continued below) (continued from above) name of course, duration of course in hours, dated completed and employee attendee. Training to be completed no later than 7/26/2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(a) · Plan of correction due date: Jul 22, 2024

87405 Administrator - Qualifications and Duties 87405 (a) All facilities shall have a qualified and currently certified administrator. This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that Josephine Credo, Administrator could not provide a copy of current Administrator Certificate or provide copy of email indicating receipt of renewal payment from CCL, which poses a immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 19, 2024

Plan of correction: Admin to submit picture of email and/or letter indicating receipt of renewal payment for Administrator Certificate from CCL or picture of current Administrator Certificate by plan of correction due date 7/22/2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: Jul 26, 2024

87412 (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that S3, S4, and S5 did not have Training records available, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 19, 2024

Plan of correction: Facility to submit pictures of completed training logs for S3, S4, and S5 by plan of correction due date. Training materials to be submitted to CCL for approval. Training logs to contain name of trainer, name of course, duration of course in hours, dated completed and (continued below) (continued form above) employee attendee name. Training to be completed no later than plan of correction due date 7/26/2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a) · Plan of correction due date: Jul 26, 2024

87412(a) The licensee shall ensure that personnel records are maintained... Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that S2, S4, and S5 did not have Heath Screens, which poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 19, 2024

Plan of correction: Facility to submit pictures of completed Health Screens for S2, S4, and S5 by plan of correction due date of 7/26/2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(c) · Plan of correction due date: Jul 26, 2024

87463 (c) The licensee shall arrange a meeting with the resident, the resident's representative.. when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that R1, R2, and R5 did not have any Appraisal Needs and Services Plan (R5 had plan present but not dated at the top of appraisal -note says to see 602, 602 dated 2022), which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 19, 2024

Plan of correction: Facility to submit pictures to CCL of current Appraisal, Needs, and Services Plans for R1, R2, and R5 by plan of correction due date of 7/26/2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR87705(c) · Plan of correction due date: Jul 26, 2024

87705(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment...This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that R1, R2, and R5 have diagnosis of Dementia but their Physician's Reports are dated 2022 which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 19, 2024

Plan of correction: Facility to submit pictures to CCL of current Physician's Report for R1, R2, and R5 by plan of correction due date of 7/26/2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Christi Coppo and Jacqueline Macias arrived unannounced to conduct a required Annual inspection and was greeted by Caregiver. Administrator, Josephine Credo arrived later. Facility contact information was reviewed. At approximately 9:30am LPAs and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPAs observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was mostly found to be stored in a safe manner with open items covered: one bottle of Tapatio sauce expired 04/2024, one bottle of sesame oil expired as of 9/18/2022, and opened jar of sardines stored at room temperature in cabinet. LPAs advised caregiver that directions on jar of sardines state to refrigerate after opening. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. Hole in the kitchen wall by outlet near door exiting to the backyard. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean, bedroom #2 had a soft spot underneath wood flooring, when pressed upon with weight, floor gives way and sinks in (deficiency cited, see 809D). Extra hygiene products and linens were available. Resident bathroom next to laundry room had non-skid mat present but mat had black spots and film underneath mat (deficiency cited, see 809D). Both bathrooms in main hallway had required grab bars. Water temperature in sink accessible to residents in care measured at 110.7 and 106 degrees F which is within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 2/19/2024. Smoke/Carbon Monoxide detectors located throughout the facility. Facility’s last quarterly disaster drills were conducted on January 25, 2024. Facility has a backup generator for use during a power outage. Continued on 809C... Continued from 809... At approximately 11:00am LPAs conducted a review of 5 resident records. R1, R2, and R5 have diagnosis of Dementia but their Physicians Reports are dated 2022 (deficiency cited, see 809D). R1, R2, and R5 did not have any Appraisal Needs and Services Plan (R5 had plan present but not dated at the top of appraisal -note says to see 602, 602 dated 2022) (deficiency cited, see 809D). At approximately 12:30am LPAs conducted review of 5 staff records. S1, S2, S3, S4, and S5 did not have current First Aid/CPR (deficiency cited, see 809D). S2, S4, and S5 did not have Heath Screen (deficiency cited, see 809D). S3, S4, and S5 did not have Training records available (deficiency cited, see 809D). At approximately 2:00pm LPAs and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet in office. LPAs and Administrator observed medication errors during spot check of R2s medication: Vitamin B12 bubble pack with start date of 5/15/2024 had one tablet missing. Levothyroxine with start date of 5/15/2024 had one tablet missing (deficiency cited, see 809D). Josephine Credo, Administrator could not provide a copy of current Administrator Certificate or provide copy of email indicating receipt of renewal payment from CCL (deficiency cited, see 809D).. Facility licensing fees due, LPAs gave caregiver LIS printout with PIN and amount due. . 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. 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 given.the state’s words, verbatim · CDSS document, May 22, 2024

The state marks this report as 10 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.