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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804373
Report Date: 02/19/2026
Date Signed: 02/19/2026 03:06:05 PM

Document Has Been Signed on 02/19/2026 03:06 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 CAREFACILITY NUMBER:
496804373
ADMINISTRATOR/
DIRECTOR:		KALRA, RAJESHFACILITY TYPE:
740
ADDRESS:6575 OAKMONT DRTELEPHONE:
(925) 683-1975
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY: 27CENSUS: 7DATE:
02/19/2026
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Rajesh Kalra, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a Post Licensing visit. LPA met with and was greeted by Rajesh Kalra, licensee. Facility currently has seven (7) residents in care one (1) of which is currently on hospice.

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. Some food was found open and unsealed or missing date of opening. LPA discussed with kitchen staff and licensee ensuring all foods, especially sugar and other staples to be properly sealed. LPA observed kitchen cabinet under sink to contain disinfectants and cleaning supplies. Cabinet has locking mechanism. LPA discussed with licensee ensuring that all disinfectants remain locked at all times. LPA discussed with licensee and kitchen staff importance of maintaining accurate and up to date temperature logs on the both the refrigerator and freezer.

All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Resident bathrooms had required bath mats and grab bars. LPA observed pull cords present in toured rooms and bathrooms. LPA tested pull cord and observed caregivers notification alert. As of now, residents do not have pendants. LPA discussed regulation 87303 which states: Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (A) Operate from each

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NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2026
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: 02/19/2026
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resident's living unit. (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. (C) Identify the specific resident living unit.

Water temperature in sinks measured at 107.8 degrees F in the kitchen and 105.4 in the community bathroom, and 114.7 degrees F in room #111, all of which are within the allowable range of 105 to 120 degrees F. Facility has another room designated staff break room.

LPA conducted a review staff records. Staff mostly have training completed. Per licensee, staff that have not completed training are on not active on the floor yet. LPA discussed with licensee ensuring all training is conducted per Health and Safety Code (HSC) 1569.625 and 1569.69. LPA also discussed with licensee that First Aid is required of all staff and that at least one staff member per shift has CPR certification. However, it may be beneficial to have all staff complete CPR/First Aid in case of scheduling changes, etc. LPA discussed with licensee importance of having all staff complete a Health Screen with TB clearance before working with residents.

LPA conducted a review of resident files. LPA discussed with licensee ensuring all orders for half rails are on file.

LPA and licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cart. LPA discussed with licensee and Health and Wellness Director (HWD) the requirement of PRN MARs, having current signed doctor's orders on file, and the maintenance of Centrally Stored Medication Log (CSML). All current doctors orders, including those orders from hospice, and PRNs must be on the CSML. Additionally, if a medication is discontinued a discontinuation order must be maintained in the resident's file.

No deficiencies cited during this inspection.

Exit interview conducted with licensee and a copy of this report was given.
NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
LIC809 (FAS) - (06/04)
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