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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800368
Report Date: 11/13/2025
Date Signed: 11/13/2025 02:25:08 PM

Document Has Been Signed on 11/13/2025 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PARADISE VALLEY ESTATESFACILITY NUMBER:
486800368
ADMINISTRATOR/
DIRECTOR:		YEE, KELLYFACILITY TYPE:
741
ADDRESS:2600 ESTATES DRIVETELEPHONE:
(707) 432-1100
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 743CENSUS: 72DATE:
11/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Phyllicia Xiong-Assisted Living Director and Sonja Duerst- Clinical Service Director TIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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At approximately 9:45 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to BEGIN a required 1-year annual inspection and met with Phyllicia Xiong-Assisted Living Director and Sonja Duerst- Clinical Service Director. Facility is a Continuing Care Retirement Community (CCRC) with a combined total of 72 residents currently residing in the assisted living and memory care units. The community is approved for a total capacity of 743 residents, of which 223 residents may be non-ambulatory. The community has a hospice waiver for 6 residents, and there is an approved delayed egress system in place in the memory care unit. Deer Creek Memory Care Unit has a current census of 16. Quail Creek Assisted Living has a current census of 32 and Willow Creek Assisted Living has a current census of 25.

At approximately 10:40 AM, LPA initiated a tour of the community's Quail Creek and Willow Creek Assisted Living Facilities and the Deer Creek Memory Care Facility and observed the following: The Quail Creek facility is a three story building and the Willow Creek and Deer Creek facilities are both one story. Each building was a comfortable temperature, and passageways were free from obstructions. LPA observed the required evacuation chairs in stairwells. Water temperature in 6 random resident bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. An staff service room in the Willow Creek Assisted Living unit, that is not readily accessed by residents was noted to have an odor and evidence of a warped and discolored melamine counter top and a technical advisory was issued to advise repair/replacement.

LPA observed a supply of hygiene, paper, and incontinent care products available for residents. Residents' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets and storage rooms containing cleaning supplies and other items that could pose a risk were locked. Community has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Food was covered, labeled, and stored in accordance with regulation. Medications were centrally stored and locked in all 3 building, including rooms and rolling lockable medicine carts.
Continued on LIC809-C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PARADISE VALLEY ESTATES
FACILITY NUMBER: 486800368
VISIT DATE: 11/13/2025
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Continued from LIC809...
The community has a fitness center with a class schedule posted with multiple classes per day offered to residents, an indoor pool, tennis courts, a massage room, a beauty salon, daily activities, crafts, puzzles, music, movies, reading areas, and more for residents in care. There are covered patios and seating areas throughout the community with outdoor space for activities. A number of rooms were noted to contain various holiday decorations ready for year long celebrations.

The community has internet service available to residents in care.

The community's fire extinguishers were observed charged and were last serviced 11/2024, and additional extinguishers were being serviced during my inspection. LPA observed a supply of PPE, emergency supplies, and flashlights, as well as a first aid bag in each building. Administrator states the community has several back up generators.

At approximately 12:10 PM LPA observed the community's infection control plan last updated 11/03/2025 and the emergency disaster plan which was last updated 11/12/2025. Smoke and Carbon Monoxide detectors were last inspected 6/2024 and are inspected semi-annually. The automatic sprinkler system is inspected semi-annually and was last inspected June 2024. The community conducts regular monthly disaster drills, and the most recent drill was conducted 09/2025.

At approximately 12:30 PM, LPA BEGAN file review of 10 staff files, LPA will need to return to continue staff file review, as well as, resident record file review.

LPA obtained updated copies of the Emergency Disaster Plan LIC610D, updated Resident Roster LIC9020A and Updated Liability Insurance today.

Technical advisory today was 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 Phyllicia Xiong-Assisted Living Director whose signature on form confirms receipt.

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC809 (FAS) - (06/04)
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