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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804303
Report Date: 04/20/2026
Date Signed: 04/20/2026 11:07:32 AM

Document Has Been Signed on 04/20/2026 11:07 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:VILLA SEVILLEFACILITY NUMBER:
496804303
ADMINISTRATOR/
DIRECTOR:		HAMILTON, CATHERINEFACILITY TYPE:
740
ADDRESS:2085 SEVILLE STREETTELEPHONE:
(707) 481-2509
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 6CENSUS: 0DATE:
04/20/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Catherine Hamilton, licenseeTIME VISIT/
INSPECTION COMPLETED:
11:21 AM
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Licensing Program Analyst (LPA) Christi Coppo arrived announced to conduct an annual inspection and was greeted by licensee Catherine Hamilton. Facility does not currently have residents in care. Once residents are admitted, licensee will submit proof of required liability insurance. Administrator certificate for Catherine Hamilton #6035280740 expires 2/2/2027. All fees are current as of this time.

Facility is a two story residence consisting of two floors. Top floor has six (6) bedrooms, two (2) staff rooms, four (4) resident bedrooms, and two (2) resident bathrooms. On the first floor there are two (2) non-ambulatory resident bedrooms, one (1) full bathroom, dining room, kitchen, living room, and family room. The facility has a west set of stairs and an east set of stairs. The facility received a fire clearance approved on 1/6/2025 by Santa Rosa Department Fire Prevention for two (2) non-ambulatory residents in rooms 1 and 2 on the first floor and four (4) ambulatory residents in rooms 3,4,5, and 6, on the second floor.

At approximately 9:30am LPA and licensee 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. LPA observed locked closet to contain cleaning supplies.

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

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NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2026
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 4
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: VILLA SEVILLE
FACILITY NUMBER: 496804303
VISIT DATE: 04/20/2026
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mats and grab bars. Facility has designated staff bathroom. LPA advised if staff bathroom is utilized by residents then no common towels can be present. Water temperature in sinks measured at 120.2 degrees F in the kitchen, 101.4 degrees F in the upstairs bathroom on the east side of the house and 117.1 degrees F in the upstairs bathroom on the west side of the house. Two (2) of these temperatures are measuring outside of the allowable range of 105 to 120 degrees F. Licensee advised that there are two (2) water heaters in the facility. LPA advised licensee that water heaters need to be adjusted so that water gets hot within a reasonable amount of time, but not too hot so as to be outside of the allowable range. Licensee will work with water heater to get it adjusted to be within allowable range.

Fire extinguishers are new and showing as fully charged. LPA advised once residents are in care that fire extinguishers should be easily located and readily accessible. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility has a backup generator for use during a power outage. Alarms on doors functional. LPA advised licensee to consider adding a stopping mechanism to the upstairs windows such they cannot be opened more than a certain height so as to prohibit the ability of residents from exiting out a window.

LPA and lciensee discussed medication storage and management including the use of Centrally Stored Medication Logs, Medication Adminsitration Records (MARs), and requirements for PRN MARs.

LPA and Licensee discussed Emergency Disaster Plan. Licensee confirmed they reviewed the LIC610E.

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:
LIC500- Personnel Report
LIC308- Designation of Responsibility
Liability Insurance (if residents are admitted)

Exit interview conducted 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: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC809 (FAS) - (06/04)
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