496804373-12-8-2025-21-AS-CCOO-DP6V7W-20251208151148

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 496804373
Report Date: 12/08/2025
Date Signed: 12/08/2025 03:12:00 PM

Document Has Been Signed on 12/08/2025 03:12 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:	AROHA MEMORY CARE		FACILITY NUMBER:	496804373
ADMINISTRATOR/ DIRECTOR:	KALRA, RAJESH		FACILITY TYPE:	740
ADDRESS:	6575 OAKMONT DR		TELEPHONE:	(925) 683-1975
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95409
CAPACITY: 27		CENSUS: 0	DATE:	12/08/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:07 AM
MET WITH:	Rajesh Kalra, Applicant		TIME VISIT/ INSPECTION COMPLETED:	03:26 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 Coppoi arrived unannounced to conduct a Pre-Licensing Inspection and met with Applicant, Rajesh Kalra. LPA and applicant initiated a tour of the facility at approximately 9:30am and made the following observations: Facility is a one story residence with twenty-two (22) single resident bedrooms, each resident room has its own private shower, some rooms have a tub/shower combo. Each bath/shower has grab bars and pull cord present. LPA and applicant discussed adding non-skid strips or mats to each bath. Facility will use SafelyYou, a fall detection and prevention technology for Memory Care communities. Each resident room therefore has a SafelyYou camera in the corner of the room, bathrooms excluded. Applicant advised LPA that disclosure of SafelyYou will be included in each resident's Admission Agreement. At this time, facility will also utilize SafelyYou in common areas. LPA advised that if video cameras are used in common areas the audio must be disabled as audio is not allowed. All camera surveillance must disclosed. Passageways were free from obstruction. All resident rooms were furnished with a small armoire wardrobe. LPA discussed regulation 87307(a)(3) and ensuring that if the resident does not provide their own items listed in 87307(a)(3) then the facility must provide it for them. Water temperature in tested bathrooms read at 105.9 degrees F in room #201 and 105.8 in room #108 which are both within the allowable range of 105 to 120 degrees F. Facility has sufficient items used for cooking. Non-perishable foods were present; per applicant, as residents move-in facility will stock perishable food. Facility has an industrial kitchen with a locking door such that it only opens with a code. Kitchen has temperature regulated freezer and two (2) refrigerators. LPA and applicant discussed regulation 87309(a)(1) requiring that disinfectants and cleaning solutions must be stored separately from food. LPA and Continued on 809C...

NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/08/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2025

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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: AROHA MEMORY CARE	FACILITY NUMBER: 496804373
	VISIT DATE: 12/08/2025

NARRATIVE

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applicant discussed storing those cleaning products needed in the kitchen under or next to the eye wash station, housed in a closing cabinet or drawer. Facility has a kitchen area located in the common area (the "country kitchen") that will have snacks and beverages freely accessible to residents in care.

Facility received an approved fire clearance dated November 5,2025 that allows for 27 non-ambulatory residents. LPA discussed with applicant that facility does not have bedridden fire clearance. LPA discussed with Admin the definition of bedridden per Health and Safety Code Section 1569.72(b)(1)…'bedridden' means either requiring assistance in turning and repositioning in bed, or being unable to independently transfer to and from bed being such that a resident cannot reposition themselves on their own. LPA discussed notification requirements of facility for the retention of bedridden residents per regulation 87606.

Fire extinguishers were last serviced October 21, 2025. Smoke/Carbon monoxide detectors and sprinklers are hardwired and serviced by a vendor; last date of service was November 7, 2025. Facility has lighting in hallways, lighting has dimming feature that will remain on at all times. LPA advised should hallway lighting turn off, night lights will need to be implemented, per regulation 87307(d)(5). LPA confirmed that contents of the facility's First Aid Kit were sufficient, facility will purchase tweezers, and that facility has emergency lighting in case of a power outage via back up generator. Facility also has supply of flashlights. Emergency food and water supplies are stored in the industrial kitchen. LPA advised facility must maintain emergency water and food for each resident, enough for at least 72 hours per Health and Safety Code 1569.695. Before residents are admitted, facility will ensure 72 hour emergency food and water supply are on hand.

Facility has three egress doors: entrance door, outdoor exit on left side of facility, and outdoor exit on right side of facility, LPA observed egress to sound appropriately. Facility has large area for outdoor activities. Outdoor areas free from obstruction. LPA discussed with applicant regulation 87219(h)(2) requiring an outdoor shaded area. Applicant showed LPA proof of purgola purchase at pre-licensing visit.

LPA observed required postings including the CCL Complaint Poster, Long Term Care Ombudsman Poster, Resident's Rights, and the rights to Resident and Family Councils.

Continued on 809(C(2)...

NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/08/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2025

LIC809 (FAS) - (06/04)

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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: AROHA MEMORY CARE	FACILITY NUMBER: 496804373
	VISIT DATE: 12/08/2025

NARRATIVE

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Medications will be secured in a locked cabinet in the Wellness room. LPA and applicant discussed adding a lock to the Wellness room door. LPA advised Applicant to sign up for the Guardian and Provider Information Notices (PINs) that the Department sends out.

Component III review conducted with applicant. LPA reviewed with applicant Health and Safety Code 1569.625 as well as 1569.69 in depth and printed for applicant. LPA discussed using approved vendor for training and the choice to conduct training on their own using materials that are current within the decade. LPA advised that using an approved vendor is not required but if they choose to conduct their own training documentation of said training must include: date, hour of duration, subject matter, instructor, and staff name/initials.

No physical plant corrections required. LPA will submit facility's application for approval.

Exit interview conducted with applicant. No deficiencies cited during this inspection

NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/08/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2025

LIC809 (FAS) - (06/04)

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