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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803880
Report Date: 11/04/2025
Date Signed: 11/04/2025 04:14:21 PM

Document Has Been Signed on 11/04/2025 04:14 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:CANTERBURY HOME, THEFACILITY NUMBER:
496803880
ADMINISTRATOR/
DIRECTOR:		FLETCHER, SOPHIE ANNAFACILITY TYPE:
740
ADDRESS:2630 CANTERBURY DRIVETELEPHONE:
(707) 578-4309
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY: 6CENSUS: 6DATE:
11/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:58 AM
MET WITH:CaregiverTIME VISIT/
INSPECTION COMPLETED:
04:29 PM
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Co-administrator Donald Fletcher (CA) arrived later and was available by phone. LPA also spoke to licensee Sophie Fletcher via Facetime. Facility currently has six (6) residents, four (4) of which are currently on hospice. While CA was at the facility LPA discussed with CA the front ramp hand rail in middle section on the right hand side. Rail is slightly loose and separated from the next following piece of rail. Rail does not present as a hazard, but could present as a potential issue in the future should it become looser. CA will fix rail piece.

Administrator is Sophie Fletcher Administrator Certificate 7019221740 expires 5/19/27. Co-administrator is Donald Fletcher Administrator Certificate 7022153740 expires 10/4/26.

At approximately 9:30am LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled with opened dates present. LPA observed kitchen cabinet under sink to contain disinfectants and cleaning supplies. Cabinet has magnetic locking mechanism. All other cleaning products and laundry soaps are secured and inaccessible to residents in care.

All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 107.8 degrees F in the main bath, 107.1 degrees F in the kitchen and 108.1 degrees F in the back bathroom all of which are within the allowable range of 105 to 120 degrees F. Facility has a small half bath used by staff only.

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NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2025
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 3
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: CANTERBURY HOME, THE
FACILITY NUMBER: 496803880
VISIT DATE: 11/04/2025
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Fire extinguishers were last inspected 06/27/25. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted on 07/28/25. LPA discussed with caregiver conducting the disaster drills quarterly.

At approximately 1:00pm LPA conducted a review six (6) staff records. LPA observed licensee to perform Health Screen for S1, S2, S3, and S4. Licensee is a practicing doctor. LPA discussed with licensee performing her own Health Screens and that it could present as a conflict of interest to perform them on her own employees. LPA observed first aid certifications for all staff to be issued by American Academy of CPR & First Aid, Inc. However, this company is not affiliated with the American Red Cross as suggested by regulation 87411(c). LPA advised caregiver. Licensee conducts medication training for all staff. LPA observed training records for S1 and S2 to include medication training but LPA could not locate medication test required of those administering medication to residents as required by Health and Safety Code 1569.69(a)(5). Additionally, three (3) of six (6) staff did not have current training records present at facility. LPA discussed with licensee and she provided copies of training records via Facetime. No deficiencies cited.

At approximately 2:00pm LPA conducted a review of six (6) out of six (6) resident files. No deficiencies cited. Licensee currently has residents with bedridden status; however, they are both on hospice. LPA advised licensee should they graduate off hospice she will need to notify the fire department and notify CCL. Once notification occurs, LPA can best advise how to proceed.

At approximately 3:00pm LPA and caregiver conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. LPA performed thorough medication management review with caregiver, discussing current physician's orders, PRNs, PRN MAR, MARs, and Centrally Stored Medication Log. No deficiencies cited.

No deficiencies cited during this inspection.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:
Liability Insurance (expires in December of 2025)
NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC809 (FAS) - (06/04)
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