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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803227
Report Date: 09/10/2025
Date Signed: 09/10/2025 02:26:30 PM

Document Has Been Signed on 09/10/2025 02:26 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:FAIRVIEW COMFORT HOMEFACILITY NUMBER:
486803227
ADMINISTRATOR/
DIRECTOR:		HARLAND, PATRICIAFACILITY TYPE:
740
ADDRESS:609 PARADISE COURTTELEPHONE:
(707) 427-8047
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 6CENSUS: 6DATE:
09/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Patricia Harland - AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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At approximately 12:25 PM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to BEGIN a required 1-year annual inspection and was greeted by Administrator Patricia Harland. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. All residents were present during today's inspection. Facility has a hospice waiver for four (4), clearance for one (1) bedridden resident. Facility currently has two (2) Hospice residents in care, and is approved for all non-ambulatory residents.

At 12:40 PM, LPA observed that facility had removed a door stop at the automatically closing door between living room and bedroom #1 as required by recent fire safety inspection performed to allow care for a bedridden resident.

At approximately 12:45 PM, LPA continued a tour of the facility with administrator and observed the following: Facility is a two story home with residents only living on the ground floor, was a comfortable temperature, and passageways were free from obstructions. Facility is noted to now have evacuation chair at top of the stairs. Water temperatures in Residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, paper products, and incontinent care briefs available to residents. Residents' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Several staff members were observed to struggle to unlock/use the under-the-sink lock where knives and toxins are stored in the kitchen and a technical advisory was issued for the facility to attain an easier/safe locking mechanism. In addition a staff room upstairs was noted to need a lock, in case staff had prescription medicines or valuables and administrator was advised to attain an easy to use door knob lock (such as popular touch pad combo locks) to ensure future safety and security from theft for residents and mobile visitors. Hallway pull-down attic stairs were climbed for LPA to observe additional storage with Christmas decorations and supplies etc.

Continued on LIC809-C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2025
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: FAIRVIEW COMFORT HOME
FACILITY NUMBER: 486803227
VISIT DATE: 09/10/2025
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Continued from LIC809
Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Administrator was advised to ensure all staff and resident foods that are taken out of their original commercial packages are labeled with the date they are put into zip-lock bags or Tupperware for refrigeration and Technical Advisory issued. Medications were centrally stored and locked. Facility does not handle resident money.

There is a covered seating area and gazebo in the backyard with outdoor space and bar-b-que for activities. Facility has an internet access device available for resident use. In addition, facility has a large hard-wired gas powered emergency generator. Facility has internet available to residents in care and the phone was tested an operational.

LPA obtained a copy of the facility's updated infection control plan and emergency disaster plan which was last updated July 2025. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights.

Administrator was advised of the need to update the recently expired "Statement of Information" (SOI) for Har Lee Mar Worldlink Corporation with the Secretary of State office.

LPA obtained the following for the facility file:
1)Updated Liability Insurance
2)LIC500 Personnel Report
3)LIC9020 Register of Facility Residents
4)LIC610E Updated emergency disaster plan
5)LIC308 Designation of Facility Responsibilty for two (2) new employees.
6)LIC9282 Updated infection control plan

Technical advisories were cited from cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code.

No deficiencies cited today

LPA will return at a later date to perform staff and resident file review and medicine administration review. This report was reviewed with Patricia Harland and Appeal rights were given.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025
LIC809 (FAS) - (06/04)
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