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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804107
Report Date: 12/09/2024
Date Signed: 12/09/2024 10:10:08 AM

Document Has Been Signed on 12/09/2024 10:10 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:NIGHTINGALE CARE HOMES LLCFACILITY NUMBER:
496804107
ADMINISTRATOR/
DIRECTOR:
KASANDRA GUERREROFACILITY TYPE:
740
ADDRESS:5161 OAK MEADOW DRIVETELEPHONE:
(707) 755-3471
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 6CENSUS: 5DATE:
12/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Cassie Guerrero (Administrator)TIME VISIT/
INSPECTION COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Cuadra and support staff Ethel Contreras arrived unannounced to conduct a case management visit and met with Administrator, Cassie Guerero.

On 12/6/24 the administrator have contacted the Department requesting guidance regarding a possible increase of capacity from six to seven residents. During today's visit, LPA/Administrator have discussed about the possibility of increasing capacity and after the conversation, the administrator acknowledged that in case that they wanted to proceed with the change of capacity process they will submit required documentation to CCL. Also, LPA/Administrator had a discussion about the facility temperature after noticing that there were some rooms where the temperature was warmer than others. The temperature observed was set at 74 degrees. Per Administrator, they are working with a contractor who will come to inspect the facility to ensure that insulation is adequate for all rooms. Also, LPA reviewed current LIC500 Personnel Report and had a conversation with Administrator regarding possible staff (S1) who are not able to fully speak English could not be left alone working providing care and supervision to residents in care. Per Administrator, there is one staff (S1) who works that have some challenges speaking the language, but they are not left alone with the residents. LPA explained to the Administrator that the licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services (technical advisory was issued).

Exit interview was conducted with Administrator and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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