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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286802019
Report Date: 09/25/2024
Date Signed: 09/25/2024 02:25:50 PM

Document Has Been Signed on 09/25/2024 02:25 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LINDA FALLS GUEST HOME 1FACILITY NUMBER:
286802019
ADMINISTRATOR/
DIRECTOR:		SACRO, NORBERTFACILITY TYPE:
740
ADDRESS:755 LINDA FALLS TERRACETELEPHONE:
(707) 963-1440
CITY:ANGWINSTATE: CAZIP CODE:
94508
CAPACITY: 6CENSUS: 5DATE:
09/25/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Norbert SacroTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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At approximately 1:40PM, Licensing Program Manager Kim Moto and Licensing Program Analyst Chris Arnhold met with Licensee Norbert Sacro in the Santa Rosa Regional Office. This informal meeting is being held to discuss concerns with the fire clearance status on the facility. Currently facility has a clearance for 3 ambulatory residents in the upstairs section and 2 non-ambulatory/1 bedridden resident in the downstairs area. During the recent annual inspection on 08/07/2024, a non-ambulatory resident was residing in an upstairs, ambulatory, room. Shortly afterwards, the resident moved from the facility.
During this meeting, ambulatory status was discussed regarding the definition of ambulatory status based on the LIC 602, Physician Report, and the mental status of the resident.
Licensee will submit an updated admission agreement to address the potential change in condition for a resident residing in an upstairs room. This update will be submitted to CCL by 10/11/2024.
LPM and LPA discussed the remaining outstanding plan of correction with Licensee. LPA cleared the violation during this meeting.

No citations issued during this meeting.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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