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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804028
Report Date: 04/14/2026
Date Signed: 04/16/2026 10:33:12 AM

Document Has Been Signed on 04/16/2026 10:33 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:TREEHOUSE SENIOR LIVINGFACILITY NUMBER:
496804028
ADMINISTRATOR/
DIRECTOR:		PATEL, DHARMISTHABENFACILITY TYPE:
740
ADDRESS:1879 ALAN DRIVETELEPHONE:
(707) 665-5624
CITY:PENNGROVESTATE: CAZIP CODE:
94951
CAPACITY: 10CENSUS: 9DATE:
04/14/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Dharmisthaben Patel, licenseeTIME VISIT/
INSPECTION COMPLETED:
01:41 PM
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Licensee Dharmisthaben Patel arrived later. Dharmisthaben Patel Administrator Certificate 7009824740 expired 1/8/27. Annual fee is due 4/20/26. Fee notification given to licensee along with PIN for online payment. Facility currently has nine (9) residents in care none of which are currently on hospice.

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 be free of leaks. All other cleaning products and laundry soaps are located in the laundry room and are 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 105.3 degrees F in the kitchen and 105.1 in the bathroom used by residents, and 105.1 in room #5, all of which are within the allowable range of 105 to 120 degrees F.

LPA observed mops and mop buckets in main resident shower room. LPA advised that shower is not storage. Staff immediately cleared out shower room. LPA observed holes in tile outside of room #6. Holes were also in other tiles but were filled with a type of filler that fills the hole. Licensee advised LPA she will have holes in tile filled within 10 days of today's visit. LPA observed scratches on toilet bowls, brown substance was removed from toilets after wiping with a cloth. LPA and licensee discussed filling in scratches so that it doesn't trap

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NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2026
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: TREEHOUSE SENIOR LIVING
FACILITY NUMBER: 496804028
VISIT DATE: 04/14/2026
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substances. LPA and licensee discussed broken door frame to main resident bathroom. Licensee explained that they recently were accidentally locked out of the bathroom and the person that fixed the lock broke the door frame but has yet to repair it. Per licensee door frame will be fixed within 10 days. Two residents (R1 and R2) had full bed rails. LPA discussed with licensee the need for an exception for full bed rails. Licensee explained they do not use the bottom rails. Licensee immediately removed bottom section of rails.

Fire extinguishers were last inspected 3/11/26. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted on 4/3/26. Facility has a backup generator for use during a power outage.

At approximately 11:00am LPA conducted a review of six (6) staff files. LPA discussed with licensee training material subject matter requirements including but not limited to including the use and misuse of antipsychotics, the interaction of drugs commonly used by the elderly, and the adverse effects of psychotropic drugs. LPA and licensee discussed using an approved vendor or purchasing training materials that are less than a decade old. Licensee would like to us an approved vendor; LPA will send list of approved vendors to licensee.

At approximately 12:00pm LPA conducted a review of six (6) out of nine (9) resident files. Files complete. No deficiencies cited.

At approximately 12:30pm LPA and licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet located in the closet. No deficiencies cited.

LPA and Licensee discussed Emergency Disaster Plan. No recent updates.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:
LIC500- Personnel Report
Liability Insurance

No deficiencies cited during this inspection. Conducted exit interview with licensee and a copy of this report given.
NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC809 (FAS) - (06/04)
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