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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803820
Report Date: 03/06/2024
Date Signed: 03/06/2024 10:47:50 AM

Document Has Been Signed on 03/06/2024 10:47 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:ENSO VILLAGE, A KENDAL AFFILIATEFACILITY NUMBER:
496803820
ADMINISTRATOR:JORDAN, ROSEMARYFACILITY TYPE:
741
ADDRESS:1801 BOXHEART DRIVETELEPHONE:
(925) 366-3414
CITY:HEALDSBURGSTATE: CAZIP CODE:
95448
CAPACITY: 138CENSUS: DATE:
03/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Nestor Mendez, VP of Operations and Rosemary Jordan, CEOTIME COMPLETED:
11:00 AM
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Licensing Program Analyst Christi Coppo and Licensing Program Manager, Bertozzi arrived unannounced to conduct a Case Management inspection and met with Administrator, Rosemary Jordan and Nestor Mendez, VP of Operations.

Floors 3-4 building I,H,G and Floor 2 of building G have been approved by the local fire department to allow for 222 non-ambulatory residents. This approval does not allow for occupancy for Assisted Living or Memory Care in any capacity. The non-approved restricted areas generally identified as such are first floor buildings I, H, G and 2nd floor buildings I, H, and the 2nd floor commercial common kitchen. On-site parking must be adequate for the actual number of occupants’ vehicles. Fire lanes are not to be blocked at any point by residents, staff or construction vehicles. This approval is an extension to the previous STD850 and includes the following units:

Floor 2 Northeast wing (G wing): U246, U247, U248, U249, U250, U251, U252, U253
Floor 3 Northeast wing (G wing): U346, U347, U348, U349, U351, U352, U353
Floor 3 North wing (H wing): U355, U356, U357, U358, U359, U360, U361, U362, U363, U364, U365
Floor 3 Northwest wing (I wing): U357, U365, U366, U367, U368, U369, U370, U371, U372, U373, U374, RES ST 375, Guest 378,
Floor 4 North wing (H wing): U455, U456, U457, U458, U459, U460, U461, U462, U463, U464, U465
Floor 4 Northwest wing (I wing): U457, U465, U466, U467, U468, U469, U470, U471, U472, U473, U474, Guest 478

Continued on LIC809C...

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ENSO VILLAGE, A KENDAL AFFILIATE
FACILITY NUMBER: 496803820
VISIT DATE: 03/06/2024
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Continued from LIC809...

LPA initiated a tour of the areas identified in Phase 3A around 9:15am and observed the following: Areas identified as needing final TCO and fire clearance have been completed. LPA confirmed through observation that the water temperature in sinks accessible to residents in care measured at 115.8, 115.6, 119.4 and 120.8 degrees F which is just outside the the allowable range of 105 to 120 degrees F. LPA discussed with VP of Operations turning the water heater down just slightly to mitigate occurrence of temperature breaking the threshold of 105 to 120 degrees F, as required per regulation.

LPA and Administrator discussed the importance of maintaining safety while area is still under partial construction.

Prior to Assisted Living and Memory Care being approved, Administrator must provide a written plan indicating how potential areas of risk including but not limited to fountains, bioswales, heaters, car garage and compacter will remain safe for residents in care.

LPA will update capacity to allow for 222 independent residents on the aforementioned floors and unit numbers.

No deficiencies cited during this visit.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
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