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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803974
Report Date: 04/13/2026
Date Signed: 04/13/2026 02:14:25 PM

Document Has Been Signed on 04/13/2026 02:14 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:L & S GENTLE CARE IIFACILITY NUMBER:
486803974
ADMINISTRATOR/
DIRECTOR:
PADAMA, SAMUELFACILITY TYPE:
740
ADDRESS:778 APPALOOSA CTTELEPHONE:
(707) 246-1100
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 6CENSUS: DATE:
04/13/2026
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Ronald Lazaro -Designation of Faciltiy Responsibiltiy TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Star Stevenson arrived unannounced at approximately 11:00 AM to conduct a required Non-Compliance Case (NCC) management inspection related to an office meeting held in Santa Rosa on 10/29/2024 the outcome of which resulted in the facility being placed on two year non-compliance plan of quarterly visits. LPA met with caregiver Ronald Lazaro who has Designation of Facility Responsibility (RP). RP called licensee Imelda Padama, who arrived at approximately 11:15 AM but then had to leave for a family commitment.

At the time of the initial office visit on 10/29/2024 the following concerns were raised to the licensee including:

1. Fire Clearance/Live-in Staff: Staff shall not sleep or reside in un-permitted/uncleared rooms or facility communal areas, LPA Karina Canela cited for the same deficiency 07/10/2023 after numerous discussions regarding the same issue on 04/19/2023, 01/25/2023, 06/28/2022, 06/02/2022, 05/23/2022.

2. Staffing: Staff must be sufficient in numbers to provide adequate care and supervision to residents in care.

3. Staff Training: Staff must complete initial training hours prior to working independently with residents.

4. Staff Medication Administration Training: Staff shall complete initial training hours prior to working independently with residents.

5. Personnel Records: Staff records shall be complete with required documentation.

6. Residnet Records: Client records shall be complete with required documentation.

Continued on LIC809C
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2026
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: L & S GENTLE CARE II
FACILITY NUMBER: 486803974
VISIT DATE: 04/13/2026
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Continued from LIC809
7. Administrator Qualifications and Duties: The administrator shall be present a sufficient number of hours to ensure facility is operating within compliance; typically 20 hours a week.

8. First Aid Requirements: The administrator shall ensure that all staff have proof of current First Aid.

9. Buildings and grounds: The shed in backyard and storage room in the garage on a prior visit were both observed unlocked with chemicals inside, as well as chemicals and a bottle of alcohol in an unlocked cabinet in the laundry room.

Facility is a Residential Care Facility for the Elderly (RCFE) with a Hospice waiver for two(2), an approved dementia plan and fire clearance for six (6) residents of which five (5) can be non-ambulatory and one (1) bedridden in room #4 only, when not on hospice care. Facility current has five(5) residents, one (1) of which is receiving hospice care.

At approximately 11:30 AM LPA initiated a tour with RP and observed the following.
Facility was a comfortable temperature, without odors and chemicals/sharps and medicines were observed to be locked. A small room in the garage contains extra supplies and paper goods. An exterior shed was found to be locked and full of DME and extra supplies.

At approximately 11:50 AM LPA reviewed five (5) staff records and LPA observed that S1 who was not working today and had a complete record except, on-site evidence of 20 hour of annual education training and a Technical Violation of Health and Safety Code (HSC) 1569.625(b)(2) was issued. LPA was told by licensee that S1 works as an "on-call" staff member.

At approximately 12:30 PM LPA review five (5) of 5 resident records and found all 5 to have the required documentation including Consent for Emergency Medical Care and Personal rights.

Technical Violation is cited from the Health and Safety Code. Failure to correct the Technical Violation may result in a civil penalty assessment in the future.

This report was reviewed with Ronald Lazaro and Appeal rights were given.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026
LIC809 (FAS) - (06/04)
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