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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804165
Report Date: 12/04/2025
Date Signed: 12/04/2025 03:57:41 PM

Document Has Been Signed on 12/04/2025 03:57 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:HILL HOUSE, THEFACILITY NUMBER:
496804165
ADMINISTRATOR/
DIRECTOR:		LUGO SOTO, ROSA I.FACILITY TYPE:
740
ADDRESS:8840 EGG FARM LANETELEPHONE:
(707) 332-4494
CITY:KENWOODSTATE: CAZIP CODE:
95452
CAPACITY: 6CENSUS: 6DATE:
12/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Rosa Soto, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:13 PM
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by licensee Rosa Soto, Administrator Cert# 7001845740 expires 8/29/27.

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. Kitchen drawer with sharp knives locked.

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. All upstairs resident bathrooms had required bath mats and grab bars. Downstairs resident shower is rarely used by resident; however it needs a grab bar installed. Facility maintenance will install a grab bar immediately. Water temperature in sink accessible to residents in care measured at 109.7 degrees F in the kitchen, 108.7 degrees F in the downstairs hallway bathroom, and 105.6 in room #1 upstairs, all of which are within the allowable range of 105 to 120 degrees F.

Fire extinguishers were last inspected 4/22/25. Smoke/Carbon Monoxide detectors and sprinklers located throughout the facility are hard wired and last serviced by Santa Rosa Fire Equipment Inc on 4/21/25. Facility is now documenting their disaster drills, LPA and licensee discussed making sure they document them every quarter. Facility has resident bedrooms located upstairs on the second floor. There is a door in the upstairs hallway that leads outside and down a steep stair case; facility has door alarm present and two locks. Facility has an evacuation chair but it is not located near the stairwell. Facility maintenance moved

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NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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.

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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: HILL HOUSE, THE
FACILITY NUMBER: 496804165
VISIT DATE: 12/04/2025
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the stairwell chair while LPA present, chair is now located immediately near the stairwell. Facility has an elevator, permit issued by the State of California, expiration date 2/2026. Facility has a backup generator for use during a power outage.

At approximately 11:30am LPA conducted a review of six (6) of six (6) resident records. No residents currently on hospice. All required documentation present. No deficiencies cited.

At approximately 1:00pm LPA conducted review of five (5) staff records. LPA discussed training materials with licensee last year and facility agreed to either update training materials or choose an approved vendor for training. Training materials used for training are videos from Community Care Options dated 2011. LPA discussed with licensee the reasons for not updating their materials as discussed last year or switching to an approved vendor. Licensee advised LPA that she will now use an approved vendor going forward, licensee advised she will use Community Care Options (CCO). LPA advised should she change her mind and choose to conduct her training herself please submit updated materials for CCL review. However, to clear deficiency issued today, licensee has stated she will use CCO. Staff have all received eight (8) hours of dementia and medication training as well as four (4) hours of hospice training. LPA and licensee discussed ensuring all staff receive training in compliance with Health and Safety Code 1569.625, which includes other required topics such as restricted conditions and postural supports. LPA also discussed with licensee that all new employees must complete 40 hours of training and existing staff must complete at least 20 hours annually (deficiency cited, see 809D). LPA discussed with licensee regulation 87411(f) requiring all staff to have a Health Screen completed before employment. LPA discussed with licensee that the required Health Screens must be completed by a physician not more than six (6) months prior to or seven (7) days after employment. S2, S3, and S5 need to have a Health Screen (deficiency cited, see 809D).


Continued on 809C(2)...

NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
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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: HILL HOUSE, THE
FACILITY NUMBER: 496804165
VISIT DATE: 12/04/2025
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At approximately 3:00pm LPA and licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. LPA discussed and reviewed with the licensee requirements for PRN MARs.

LPA discussed with licensee regulation 87303(i)(2), the requirement to have a signal system that is operation for all residents. LPA discussed with licensee that the system must operate from each resident's living unit, transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff, and identify the specific resident living unit. Licensee will purchase a signal system that is in compliance with regulation.


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
LIC308- Designation of Responsibility
Liability Insurance

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted with licensee and a copy of this report was given.

NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
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Document Has Been Signed on 12/04/2025 03:57 PM - It Cannot Be Edited


Created By: Christi Coppo On 12/04/2025 at 03:36 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: HILL HOUSE, THE
FACILITY NUMBER: 496804165

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(f)
Personnel Requirements - General
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA amd licensee record review, the licensee did not comply with the section cited above in that S2, S3, and S5 need a Helath Screen which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/18/2025
Plan of Correction
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Facility to submit to CCL copies of Health Screens for S2, S3, and S5 (TB clearance not needed) by plan of correction due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Victoria Bertozzi
NAME OF LICENSING PROGRAM MANAGER:
Christi Coppo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2025


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Document Has Been Signed on 12/04/2025 03:57 PM - It Cannot Be Edited


Created By: Christi Coppo On 12/04/2025 at 03:36 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: HILL HOUSE, THE
FACILITY NUMBER: 496804165

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(b)(2)
Other Provisions
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA and licensee record review, the licensee did not comply with the section cited above in that S1, S2, S3, S4, and S5 did not have required training completed, both in total hours and subject matters which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/25/2025
Plan of Correction
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Facility to submit training certificates from Community Care Options for all staff in required number of hours by plan of correction due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Victoria Bertozzi
NAME OF LICENSING PROGRAM MANAGER:
Christi Coppo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2025


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