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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804324
Report Date: 11/13/2025
Date Signed: 11/13/2025 03:25:33 PM

Document Has Been Signed on 11/13/2025 03:25 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:RESERVE AT FOUNTAINGROVE MEMORY CARE, THEFACILITY NUMBER:
496804324
ADMINISTRATOR/
DIRECTOR:		DOWNEY, DENISEFACILITY TYPE:
740
ADDRESS:200 FOUNTAINGROVE PKWYTELEPHONE:
(707) 544-4909
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 64CENSUS: 25DATE:
11/13/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Denise Downey, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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At approximately 8:15AM, Licensing Program Analyst (LPA) Hansen arrived unannounced to conduct a Pre-Licensing inspection and was greeted by Denise Downey, Administrator. This is a change of ownership (CHOW) with 25 residents in care. On 02/20/2025 new property management company Onelife Senior Living LLC became effective. This CHOW is for Applicant OOC-Santa Rosa,LLC; and Onelife Senior Living LLC. Facility received an approved fire clearance dated 07/07/2025 that allows for a total capacity of 64 Non Ambulatory residents, of which 12 may be bedridden. Facility is full memory care with a Dementia Care Program on file.

At approximately 8:45 AM LPA conducted a walk-through of facility with Administrator and observed the following: Facility is single story with East and West mirrored sides each containing, 32 apartments, dining rooms, courtyards, and each having an activity room. There is also a salon, commercial kitchen, private dining room, offices, common spaces, and indoor and outdoor activity spaces. Facility was clean and at a comfortable temperature with all exits free from obstruction. Facility has emergency lighting. Facility has an Infection Control plan on file. A sample size of 8 resident bathroom sinks were found to be within Title 22 Regulations of 105 degrees F to 120 degrees F. Bathrooms and showers were textured and equipped with necessary grab bars, slip resistant strips and built in shower chairs for safety. Apartments contained required furnishings. LPA observed a sufficient supply of perishable and non-perishable foods necessary for residents in care, along with emergency food and water supply. Residents with special diets posted in kitchen and menus are supplied for residents at each meal with specials each day. Facilities fire extinguishers were inspected 08/05/2025. Facility smoke and carbon monoxide detectors tested by Fire Inspector on 07/03/2025. Fire Sprinkler system tested 11/11/2025. Facility has commercial generator for electrical emergencies. Facility’s First Aid Kits were sufficient. Facility has medication room and two medication carts, one for each side of facility. There is an RN and an LVN available 24 hours per day, on-cite 16 hours per day. Facility utilizes a call light system. Monthly activity calendar posted throughout facility, that includes 5 days of interactive entertainment; morning exercise, music, holiday craft making, dessert making, outings once a week.

Continue on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Shannan Hansen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2025
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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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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: RESERVE AT FOUNTAINGROVE MEMORY CARE, THE
FACILITY NUMBER: 496804324
VISIT DATE: 11/13/2025
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Continued from LI809

Required posters for Long Term Care Ombudsman and Complaints were located in each (2) dining/common room areas, across from staff break room and in lobby. Egress doors on all 4 exits accessible to residents have audible alarms when doors are opened without access codes. Doors tested during today’s inspection working properly, with staff responding appropriately. Emergency disaster drills are conducted monthly during different shifts with the last conducted on 10/08/2025. Toxins secured in numerous storage rooms inaccessible to residents in care.

Component III was reviewed with Administrator.

No Deficiencies or Advisories given during visit. Pre-Licensing completed. Facility is ready to be Licensed as a Residential Care Facility for the Elderly.

Facility to follow up with CAB regarding Hospice Waiver.

LPA will submit TSP referral for future Administrator

LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Analyst will notify Applicant of Status.

LPA will conduct medication review and file review at Post-Licensing inspection.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Shannan Hansen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC809 (FAS) - (06/04)
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