<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804252
Report Date: 01/03/2025
Date Signed: 01/03/2025 12:55:24 PM

Document Has Been Signed on 01/03/2025 12:55 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:CLAREMONT HOME FOR ELDERSFACILITY NUMBER:
496804252
ADMINISTRATOR/
DIRECTOR:
BISCOCHO, LIZAFACILITY TYPE:
740
ADDRESS:3106 CLAREMONT DR.TELEPHONE:
(707) 889-0565
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY: 6CENSUS: DATE:
01/03/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:01 AM
MET WITH:Applicant Liza BiscochoTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a pre-licensing inspection and was greeted by applicant. Administrator certification: Liza Biscocho Administrator Certificate 7005426740 expires 6/19/2026.

At approximately 9:30am LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. Facility does not currently have residents in care. LPA discussed with applicant once residents are in care, facility must have at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food must be stored in a safe manner with open items covered and labeled with date of opening. LPA observed, within regulation, emergency supply of non-perishable food. Cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives inaccessible to residents in care. Medication will be stored in a locked cabinet.

Facility is a one story residence with six [6] bedrooms, two [2] full bathrooms, kitchen and dining and living room common areas. The 6th bedroom is actually split in to two [2] 9x8 rooms off of the kitchen dining room. Applicant advised LPA that these rooms did not receive non-ambulatory fire clearance and so will be used as staff rooms or for storage.

All resident rooms are furnished per regulation with a bed, lamp, dresser, chair and bedside table. LPA and applicant discussed providing chairs in bedrooms that are comfortable for relaxing or visitation, rather than metal folding chairs. Light-switch for room #1 is located in the kitchen, applicant to fix light-switch in room #1 so that the light-switch inside the room operates the light inside the room. Room #2 has a bed, but the bed is wobbly and slightly unstable; applicant agrees to repair or replace it. Room #5 is a shared room with a full bath. Applicant to add grab bar closer to toilet in room #5. One chest of drawers present in room #5; however, it is a shared room and each resident requires their own chest of drawers. Applicant to add chest of drawers to room #5 that provides at least a minimum of eight (8) cubic feet of drawer space. Rooms that have exit sliding doors have alarms present and functioning.

Continued on 809C...
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2025
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 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: CLAREMONT HOME FOR ELDERS
FACILITY NUMBER: 496804252
VISIT DATE: 01/03/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from 809...

Facility has dryer in the garage and 2 washing machines inside the facility. All laundry soaps are stored underneath bathroom sink in locked space. All kitchen cleaning supplies locked underneath kitchen sink.

Outside area available for recreation and visitation but does not have shaded area. LPA and applicant discussed adding a canopy/gazebo to backyard deck to provide shade.

Fire extinguishers were last inspected 1/15/24. Smoke/Carbon Monoxide detectors located throughout the were tested and operational. Water temperatures read at: 107.1 degrees F in the kitchen and 108.9 degrees F in main bath which are within the allowable range of 105 to 120 degrees F.

Facility has two [2] fire doors: the door of room #1 and the door that leads to the hallway and other facility bedrooms. Applicant advised LPA that they received conflicting instruction from the fire inspector as pertains to the fire door leading to the hallway and bedrooms. Applicant advised LPA that one fire inspector said that the door must remain closed at all times and the other told them it was okay to have the door propped open. LPA discussed concerns with applicant about the fire door remaining closed as it would be hard for residents to open, but a propped open door could present a safety hazard to residents should the stopper fail and the door start to move and/or close on a resident. The door is very heavy and takes some effort and strength to open and/or control. LPA and applicant discussed removing door all together. Applicant advised the fire door was a requirement for fire clearance. LPA will confirm with both fire inspectors and advise applicant of determination.

The following items need to be corrected and/or added prior to LPA submission of facility's application for approval: outdoor canopy or gazebo for backyard deck to provide shaded area, repair or replace bed in room #2, add grab bar by toilet in room #5, add a chest of drawers to room #5, and fix light-switch for room #1. Once acceptable photographic or video proof is received by CCL, LPA will submit facility's application for approval.

Comp III reviewed. Exit interview conducted with applicant and copy of report given
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2