Admission, assessment, and eviction
Cited in 2 reports, with 2 deficiencies in total.
611 CHERRY CREEK ROAD, Cloverdale CA 95425
13 bedsLatest official report Nov 7, 2025Licensed
The available records show 10 Type B deficiencies for this facility.
No later report is available, so the records do not show what happened afterward.
Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.
Counts cover the five-year public record. Typical figures are the median for the 16 Sonoma County facilities licensed for 7 to 15 beds, except where too few exist to state one — those come from facilities with 7 or more beds.
In the available public five-year record, CCLD published 8 reports for this facility: 6 inspections, 0 complaint investigations, and 2 licensing or administrative records.
Those records contain 0 Type A and 10 Type B deficiencies.
0 deficiencies have explicit official correction or clearance evidence in the loaded records.
Fewer than the typical 9
1 in the last 12 months
More than the typical 9
5 in the last 12 months
Fewer than the typical 4
0 in the last 12 months
Well above the typical 5
5 in the last 12 months
Fewer than the typical 2
0 in the last 12 months
Last 36 months
Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.
Cited in 2 reports, with 2 deficiencies in total.
Cited in 2 reports, with 2 deficiencies in total.
All preserved reports from the most recent to the oldest, sortable by report type.
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that the sprinkler and fire alarm system have not had an annual inspection since 2/2023 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2025 Plan of Correction Licensee to have the sprinkler and fire alarm system inspected and will send inspection documents to Community Care Licensing by the POC due date of 12/1/2025.
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that there are exposed wires in the fire sprinkler control closet in the bathroom at the rear of the facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2025 Plan of Correction Licensee to have exposed wires put into a junction box or use other means to secure the wires to ensure that they are no longer exposed. Licensee will send photographs of secure wires to Community Care Licensing by POC due date of 12/1/2025.
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in that one (1) of five (5) files were observed (for resident R2) not to have a current resident appraisal/Needs and Service Plan which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2025 Plan of Correction Licensee will submit a completed and signed updated resident appraisal/Needs and Service Plan to Community Care Licensing by POC due date of 12/1/2025.
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above that the facility does not maintain an Emergency Disaster Drill log which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2025 Plan of Correction Licensee to submit a completed Emergency Disaster Drill Log showing that an actual drill was conducted to Community Care Licensing by POC due date of 12/1/2025.
87468 Personal Rights (b)At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1)The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities or and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (A)The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in that two (2) of five (5) resident files were observed (for residents R1 and R3) to not have LIC 613C Personal Rights document which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2025 Plan of Correction Licensee to submit signed LIC 613C Personal Rights documents for residents R1 and R3 to Community Care Licensing by POC due date of 12/1/2025.
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that S1 did not have a Health Screen on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/03/2025 Plan of Correction Facility to submit picture of completed Health Screen for S1 by plan of corrrection due date.
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and Admin observation, the licensee did not comply with the section cited above in that he main bathroom across from the living room has a little closet that houses the sprinkler equipment. The door to the closet is splintering and cracking at the bottom posing a safety hazard to residents. The main bath next room #9 has a wood/plywood/sheathing on the bottom/base of the vanity cabinet has a black substance present with spots and dots of a white fuzzy substance, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025 Plan of Correction Facility to submit pictures of replaced bottom of cabinet in bathroom next to rm #9 and submit picture of replaced door on closet in main bathroom across from living room by plan of crrection due date.
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and Admin observation, interview, and record review, the licensee did not comply with the section cited above in that all continuing staff have not completed the required 20 hours of annual training, and staff (S3) is a new hire as of 2024 and has not completed the required 40 hours of training, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/06/2024 Plan of Correction Facility to submit proof of 4 hours of training for S1, S2, S4, S5 and 24 hours of training for S3 by plan of correction due date. Proof to include topic (which needs to meet regualtion requriements of topics), date of training completed, and duration of hours completed,
(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA record review, the licensee did not comply with the section cited above in that R3 did not have a curent appraisal on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/27/2024 Plan of Correction Facility to submit appraisal for R3 by plan of correction due date
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation and record review, the licensee did not comply with the section cited above in that R1, R2, and R4 did not have a current physician's report or a current appraisal (both) on file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025 Plan of Correction Facility to submit to CCL physician's reports and appraisals for R1, R2, and R4 by plan of correction due date.
California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.
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