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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496800794
Report Date: 07/22/2025
Date Signed: 07/22/2025 03:19:03 PM

Document Has Been Signed on 07/22/2025 03:19 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:SUNSET HOUSEFACILITY NUMBER:
496800794
ADMINISTRATOR/
DIRECTOR:		CATTICH, DOUGLASFACILITY TYPE:
740
ADDRESS:9408 WILLOW AVETELEPHONE:
(707) 795-7882
CITY:COTATISTATE: CAZIP CODE:
94931
CAPACITY: 9CENSUS: 7DATE:
07/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Douglas Cattich, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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License Program Analyst (LPA) Hansen arrived unannounced to conduct an Annual Required – 1 yr. visit of the facility. LPA was welcomed by Licensee/Administrator Doug Cattich. Facility is a single story 9 bedroom (1 staff & 1 double) RCFE that has a fire clearance for 9 Nonambulatory residents, of which 1 may be bedridden. There is currently a total of 7 residents, 5 with a dementia diagnosis and no currently under Hospice services.

LPA toured the facility on 7/22/2025 at 8:45 AM with Licensee/Administrator Doug Cattich; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices, and doors were activated at the time of the visit. Hot water temperature measured between 107.2 degrees F and 114.4 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 5 of 5 resident’s bathrooms while touring facility on 7/22/2025 at 9:10 AM. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the laundry room of the facility. Dangerous items are stored inaccessible to residents with dementia. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with individual towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, although main bathroom where showers are given does not have slip-resistant mats, strips, or flooring in shower floor as required by Title 22 regulations. Facility was given TA during last years inspection for this issue on 7/25/2024 (see pics & LIC809-D). All bedrooms have lighting & appropriate furnishings. Receipt posted of pest control service, per Licensee monthly, last conducted 6/3/2025. Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Shannan Hansen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2025
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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Document Has Been Signed on 07/22/2025 03:19 PM - It Cannot Be Edited


Created By: Shannan Hansen On 07/22/2025 at 12:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SUNSET HOUSE
FACILITY NUMBER: 496800794

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(e)(5)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation during annual inspection, the licensee did not comply with the section cited above in main shower does not have non-skid mat or strips and was provided TA at last years inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2025
Plan of Correction
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Licensee to install or provided slip-resistant mats or strips. Provide picture of either stips installed or mats to clear citation by POC due date of 7/31/2025 to CCL/LPA.
Type B
Section Cited
CCR
87303(c)
87303(c) Maintenance and Operation All window screens shall be clean and maintained in good repair. This requirement was not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation (see pics) & interview with Licensee , the licensee did not comply with the section cited above in 5 window screens were missing, 4 to bedrooms which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2025
Plan of Correction
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Licensee to replace window screens and submit receipt and pictures of completion to LPA Hansen by POC due date 7/31/2025 to clear citation.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Shannan Hansen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2025


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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SUNSET HOUSE
FACILITY NUMBER: 496800794
VISIT DATE: 07/22/2025
NARRATIVE
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Continued from LIC809:

Facility is missing 5 window screens that need to be replaced (see pics LIC809-D).

A review of seven resident & five staff records as well as two resident’s medications was conducted. LPA reviewed resident’s files at 10:00 AM on 7/22/2025 and learned that 7 of 7 residents have an updated reappraisal/needs & care plan, TB and physician’s assessments on file as required by Title 22 Regulation.

At approximately 11:15 AM LPA reviewed a sample of staff records and learned that all facility staff present and other individuals who require caregiver background checks have received criminal record clearances or exemptions. In addition, Direct care staff at the facility have received the additional training required. LPA was presented with proof of CPR & 1st Aid certification for staff that files were reviewed. Doug Cattich Administrator Certificate # 7002018740 expires on 8/11/2025.

Medications were centrally stored in two locked cabinets in the facility kitchen. At approximately 12:00pm LPA conducted sample review of 2 out of 2 residents medications, which were found to be given according to physicians’ directions on 7/22/2025. However, residents medications have been 24 hour pre-poured and new regulation 87465(h)(5) states No medications shall be transferred between containers. (see LIC 9102 Advisory Notes) Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate.



In addition. Fire Extinguisher was found to be last charged on 6/26/2025 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Fire sprinkler inspection conducted 7/2025 indicated several deficiencies for gauge on sprinkler riser expired, bell sign faded, spare head box needs replacement quick response heads older than 20 yrs require UL testing prior to replacing new heads, and other items that require action to ensure continued safety and functionality of the fire sprinkler system. LPA requesting update once corrected. Disaster Drills have been conducted quarterly with the last one being conducted on 6/10/2025. Facility has portable generator in case of emergency & power goes out. Facility’s backyard has been under construction for the last month due to rebuilding of patio (see pics) and per Licensee should be completed by end of summer. LPA discussed plan of keeping residents safe from the rusted wire sticking up from the ground until cement is poured and construction complete.

Continue LIC809-C2

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Shannan Hansen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SUNSET HOUSE
FACILITY NUMBER: 496800794
VISIT DATE: 07/22/2025
NARRATIVE
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Continued from LIC809C:

Appeal of Rights Given.

The following deficiencies were observed (see LIC 809D) and 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 and appeal of rights provided.

LPA Hansen is requesting Licensee to update and submit the following documents by 8/8/2025 to CCL/SRRO:

LIC 308 Designation of Facility Responsibility

LIC 500 Personnel Record

LIC 610 Emergency Disaster Plan (if changes)

LIC 9020 Residents Roster

Copy of Administrator Certificate

Proof of Liability Insurance

Proof of corrections to Fire Sprinkler System (due 8/15/2025)

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Shannan Hansen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC809 (FAS) - (06/04)
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