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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804042
Report Date: 02/05/2026
Date Signed: 02/05/2026 11:21:56 AM

Document Has Been Signed on 02/05/2026 11:21 AM - 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:BICKFORD HOMEFACILITY NUMBER:
486804042
ADMINISTRATOR/
DIRECTOR:		ANGEL LAWRENCE DEANFACILITY TYPE:
740
ADDRESS:5083 BICKFORD CIRCLETELEPHONE:
(707) 344-2628
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 4DATE:
02/05/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Licensee Alma CorsigaTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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At approximately 8:25 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff member Ryan Bernado. Administrator and licensee were notified of today's inspection and licensee Alma Corsiga arrived at 8:35 AM, while administrator Angel Dean arrived at approximately 9:00 AM to assist with today's inspection.

Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care. Three (3) residents were away from the facility either at Day Program or on a community outing and one (1) resident was present during today's inspection. Facility has a hospice waiver for two (2), with no hospice residents currently in care, and is approved for all non-ambulatory residents.

At approximately 09:00 AM, LPA initiated a tour of the facility with administrator and observed the following: Facility is a two story home, was a comfortable temperature, and passageways were free from obstructions. All residents live on the first floor of facility and Licensee's family lives on the second floor. 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.

The drawer faces of two (2) kitchen drawers that were empty were missing and LPA observed fence boards, poles and other debris that could present a tripping hazard present and a Technical Advisory for facility maintainence and repair was issued. CCR 87303(a)

Continued on LIC809-C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2026
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: BICKFORD HOME
FACILITY NUMBER: 486804042
VISIT DATE: 02/05/2026
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Continued from LIC809
LPA observed sharps and laundry room chemicals locked in laundry room behind coded door. Facility has at least two days of perishable food and 7 days non-perishable food in the event of an emergency.
LPA observed wilted cauliflower and lettuce in a garage refrigerator that was said to represent a "staff" refrigerator and licensee was advised that the department does not distinguish between staff and resident food storage and a Technical Advisory was issued for CCR food storage 87555(b)(9).

There is a covered seating area in the backyard with outdoor space for activities. LPA observed the fence in the backyard on the left side is now repaired. Facility has internet available to residents in care and the phone was tested an operational.

Facility's fire extinguisher was observed charged and was last serviced 01/2026. Smoke and Carbon Monoxide detectors were tested and found operational. Facility conducts quarterly Emergency and Disaster Drills with the last drill on 01/11/2026. LPAs observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. Facility does not have a back up generator.

At approximately 09:45 AM, LPA reviewed five (5) staff files and four (4) resident files. Five (5) of 5 staff files reviewed have all the required paperwork and four (4) of (4) resident files reviewed have all the required paperwork. Licensee states facility coordinates medical and dental visits for the residents and provides transportation to and from their appointments.

At approximately 10:30 AM, LPA reviewed medications and medication records which were centrally stored and locked and correctly administered.

At approximately 10:45 AM P&I monies was observed to be stored and correctly accounted for. In addition, LPA obtained an updated Surety Bond and Affidavit for Client/Resident cash resources.

Updated copies of the following documents were obtained today for the facility file including::
  • LIC400 - Updated Affidavit Regarding Resident Cash Resources
  • LIC402 - Updated (increased) Surety Bond
  • LIC9020- Register of Facility Resident- RCFE
Continued on LIC809C
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
LIC809 (FAS) - (06/04)
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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: BICKFORD HOME
FACILITY NUMBER: 486804042
VISIT DATE: 02/05/2026
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Continued from LIC809C

License to provide updated LIC 500 Personel Roster by 03/03/2026 to update facility file.

Technical Advisories are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited Advisories, may result in a future civil penalty assessment.



Appeal rights were given. Exit interview conducted with Licensee 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: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
LIC809 (FAS) - (06/04)
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