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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804306
Report Date: 05/13/2025
Date Signed: 05/13/2025 01:16:47 PM

Document Has Been Signed on 05/13/2025 01:16 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:SILA HOME CAREFACILITY NUMBER:
496804306
ADMINISTRATOR/
DIRECTOR:		MUTUNGA, EMMA SILAFACILITY TYPE:
740
ADDRESS:2185 FLORAL WAYTELEPHONE:
(707) 545-6464
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 6CENSUS: 4DATE:
05/13/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Emma Mutunga-ApplicantTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Alviso conducted a pre-licensing inspection at approximately 9:45am on 5/13/25, and met with Applicant Emma Sila Mutunga. Emma Sila will be the facility's, Sila Home Care, Administrator.

This application is a change of ownership, and is currently licensed as "Alvarez Family Home" #496800549. Emma Sila Mutunga is the current Administrator for Alvarez Family Home.

Applicant will be submitting a hospice care waiver request to the application packet being processed. Applicant has submitted a dementia plan with their application. Applicant has submitted a required emergency disaster plan, and a required infection control plan.

Applicant has an approved fire clearance for four (4) non-ambulatory residents, in room #1 & #3, and two (2) ambulatory residents in room #2, effective 10/19/2024. There is a carbon monoxide detector in the facility that was working properly during the inspection. All required rooms have a smoke alarms as required by the local Fire Department. Fire extinguisher were serviced and tagged as required. All exits were free and clear from obstruction. All exits had auditory alarms.

The LPA toured the facility with applicant. Bathrooms had grab bars and non-slip mats for the showers for resident use as needed. Hot water was measured at 115.5 degrees Fahrenheit.

All resident rooms were clean, orderly, and had all required accommodations. Facility had sufficient lighting in resident rooms, bathrooms, and common areas. Medications were centrally stored in a locked storage cabinet.

Continued on LIC809C...

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2025
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 3
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: SILA HOME CARE
FACILITY NUMBER: 496804306
VISIT DATE: 05/13/2025
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All disinfectants/cleaners/soaps were locked up and inaccessible. Facility had a supply of food, perishable and non-perishable. Facility had a sufficient supply of linens, dishes, and furnishings for resident use. The fire exit ramps were free and clear of obstruction, one is off of resident room #3 in the backyard area, and the other one is in the front of the house, from the exit door of the facility's laundry room. All outside walkways/pathways were free and clear of obstruction as required.

Component III orientation was held with Applicant Emma Sila Mutunga, on 5/13/25.

The following items need to be corrected/completed:


Facility has a large amount of boxes in the front door foyer area, which are full of incontinent supplies. The boxes cover one whole side of the entry's double front door, and continues along the side of the wall. The applicant stated the boxes are being moved to storage in the garage that will be available soon. LPA obtained photos.

Facility had a large portion of the garage full of open boxes with tools/items, furniture items, and miscellaneous items; Applicant stated they are needing to be taken and/or picked up for donation or to the dumps. Some paint cans, caulking, paint brushes, and some miscellaneous items were put in a locked storage cabinet by the applicant. LPA obtained photos.

LPA observed in the front of the house, the front yards side fencing had a large portion missing due to the fence falling down and/or breaking down due to age of the fence. There is a bit of a drop from the fence line, where the ground is uneven and goes down,which may be a trip hazard to residents in care. Applicant is installing a barrier/fencing/gates to ensure the front side area is not a health and safety hazard/risk to residents in care. LPA obtained photos.

Applicant is dusting, and cleaning all windows, window screens, and glass doors.

Applicant will contact the LPA when all items are complete; The LPA will return to continue the inspection at a later date.

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC809 (FAS) - (06/04)
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