Medication handling and storage
Cited in 10 reports, with 14 deficiencies in total.
Jul 10, 2026May 6, 2026Jan 13, 2026Oct 24, 2025Aug 22, 2025Jun 11, 2025Apr 24, 2025Oct 30, 2024Jun 19, 2024Oct 10, 2023
BETSY'S II RCFE
3101 BRUSH CREEK ROAD, Santa Rosa CA 95404
13 bedsLatest official report Aug 5, 2026Licensed
Additional info
- Telephone
- (707) 537-0399
- Licensee
- 3ERA LLC
- Administrator
- ALICDAN JR, EDWARD
- Contact
- ALICDAN JR, EDWARD
- License first date
- Jun 1, 2007
- License effective date
- Jun 1, 2007
- District office
- SANTA ROSA RO · (707) 588-5026
- Regional office
- 21
- Clients served
- 983 - RCFE / DEMENTIA
Summary
The available records show 38 Type A and 41 Type B deficiencies for this facility.
- Most recent inspection
- Jul 10, 2026
- Most recent deficiency
- Jul 30, 2026
No later report is available, so the records do not show what happened afterward.
What Type A and Type B mean
- Type A
- 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
- Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.
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.
At a glance
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 30 reports for this facility: 15 inspections, 12 complaint investigations, and 3 licensing or administrative records.
Those records contain 38 Type A and 41 Type B deficiencies.
5 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 15
- Recorded deficiencies
- 79
- Type A deficiencies
- 38
- Type B deficiencies
- 41
- Substantiated complaints
- 6
- Repeated topics
- 13
More than the typical 9
6 in the last 12 months
Well above the typical 9
29 in the last 12 months
Well above the typical 4
13 in the last 12 months
Well above the typical 5
16 in the last 12 months
More than the typical 2
2 in the last 12 months
Last 36 months
Repeated topics
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.
Facility condition and maintenance
Cited in 9 reports, with 11 deficiencies in total.
May 6, 2026Oct 24, 2025Apr 24, 2025Nov 13, 2024Oct 30, 2024Oct 24, 2024Oct 3, 2024Jun 19, 2024Oct 10, 2023
Staffing, personnel, and training
Cited in 7 reports, with 11 deficiencies in total.
May 6, 2026Jun 11, 2025Apr 24, 2025Nov 13, 2024Oct 30, 2024Jun 19, 2024Oct 10, 2023
Admission, assessment, and eviction
Cited in 5 reports, with 5 deficiencies in total.
Administrator qualifications
Cited in 4 reports, with 4 deficiencies in total.
Hazardous items and storage
Cited in 4 reports, with 4 deficiencies in total.
Resident rights
Cited in 4 reports, with 4 deficiencies in total.
Food service
Cited in 3 reports, with 4 deficiencies in total.
Medical and dental care
Cited in 3 reports, with 4 deficiencies in total.
Background checks
Cited in 3 reports, with 3 deficiencies in total.
Dementia care
Cited in 2 reports, with 3 deficiencies in total.
Health conditions and treatments
Cited in 2 reports, with 3 deficiencies in total.
Incident reporting
Cited in 2 reports, with 2 deficiencies in total.
Official report history
All preserved reports from the most recent to the oldest, sortable by report type.
Complaint
Allegations2 substantiated · 1 unsubstantiated · 0 unfounded · 3 cited
Medical and dental careType A
- Official classification
- Type A
- Official code
- 87465(a)(1)
- Regulation authority
- CCR
What the official deficiency says
87465 Incidental Medical and Dental Care (a) A plan...The plan shall encourage...obtaining such care, by compliance... (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on interview & record review, the licensee did not comply with the section cited above in that staff did not seek timely medical care for resident R1 which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
Licensee will provide training for all staff members, on all shifts in Psychosocial and Physical needs of the elderly, Physical Environment and resident rights and will further provide training in California Code of Regulations 87465 Incidental Medical and Dental Care to all staff members. Proof of all training to be submitted to Community Care Licensing by POC due date of 7/31/2026.
Deadline recorded: Jul 31, 2026. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jul 31, 2026
Correction not verified in available records
Basic services and supervisionType B
- Official classification
- Type B
- Official code
- 87466
- Regulation authority
- CCR
What the official deficiency says
87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes...When changes...are observed,...brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interview & record review, the licensee did not comply with the section cited above in that staff did not report changes in the health condition for R1 to R1’s responsible party which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
Facility to update their plan to ensure communication on all shifts related to residents in care and any/all changes of condition. Facility to provide a copy of the updated plan along with a roster of staff trained on new plan by POC due date of 8/13/2026.
Deadline recorded: Aug 13, 2026. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Aug 13, 2026
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468.2(20)
- Regulation authority
- CCR
What the official deficiency says
87468.2 Additional Personal Rights... (20) To be protected from involuntary...evictions. A licensee shall not...evict residents for reasons other than those permitted by state law... " involuntary " means...eviction that is initiated by the licensee, not by the resident. This requirement is not met as evidenced by: Based on interview and express admission, the licensee did not comply with the section cited above in that resident R1 was not allowed to return to the facility from a doctors appointment which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
Licensee to submit an LIC 9098 Self Certification that they have read and understand California Code of Regulations (CCR) 87224 Eviction Procedures and CCR 87468.2 Additional Personal Rights of Residents in Privately Operated Facilities to CCL by POC due date of 8/13/2026.
Deadline recorded: Aug 13, 2026. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Aug 13, 2026
Correction not verified in available records
Complaint
Allegations3 substantiated · 0 unsubstantiated · 0 unfounded · 4 cited
Medical and dental careType A
- Official classification
- Type A
- Official code
- 87465(e)
- Regulation authority
- CCR
What the official deficiency says
87465 Incidental Medical and Dental Care (e) For every prescription and non prescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, ... This requirement is not met as evidenced by: Based on interviews & record review, the licensee did not comply with the section cited above in that the facility administered medication-1 that was not prescribed for R1 until 4/3/2026 was administered seven (7) times between the dates of 3/26/2026-4/2/2026. which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
Licensee and all facility staff who assist with the self-administration of medicine shall complete eight (8) hours of in-service training on Medication Management and medication related issues. Licensee to provide proof of training and all training curriculum to Community Care Licensing by POC due date of 7/13/2026.
Deadline recorded: Jul 13, 2026. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jul 13, 2026
Correction not verified in available records
Medical and dental careType A
- Official classification
- Type A
- Official code
- 87465(a)(4)
- Regulation authority
- CCR
What the official deficiency says
87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall...by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation & record review, the licensee did not comply with the section cited above in that medication-1 was administered to R1 six (6) times in a week, the amount of medication administered exceeds the doctor’s orders as shown on the prescription label which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
Licensee is to have a 3rd party pharmacy or pharmacy consultant complete a full audit of the facility’s medications and medication management program. Licensee to provide Community Care Licensing the name of the 3rd party pharmacy or pharmacy consultant, audit findings and the date on which the audit will be conducted to Community Care Licensing by POC due date of 7/13/2026.
Deadline recorded: Jul 13, 2026. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jul 13, 2026
Correction not verified in available records
Medication handling and storageType A
- Official classification
- Type A
- Official code
- 87465(h)(6)(E)
- Regulation authority
- CCR
What the official deficiency says
87465 Incidental Medical and Dental Care (h)The following... to medications which are centrally stored: (6) The licensee shall be responsible...is maintained for at least one year and includes: (E) The prescription number...This requirement is not met as evidenced by: Based on observation & record review, the licensee did not comply with the section cited above in that the facility’s Centrally Stored Medication and Destruction Records were observed not to have the prescription number which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
Licensee to submit completed Centrally Stored Medication and Destruction Records for all facility residents to Community Care Licensing by POC due date of 7/13/2026.
Deadline recorded: Jul 13, 2026. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jul 13, 2026
Correction not verified in available records
Not classified in the sourceType A
- Official classification
- Type A
- Official code
- 1550(c)
- Regulation authority
- HSC
What the official deficiency says
1550 Licenses or administrator...The department may...suspend or revoke, any license,...(c) Conduct which is inimical to the health, morals, welfare, or safety of either the people of this state or an individual in, or receiving services from, the facility or certified family home. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above in that the PRN logs for medication-1 provided to the LPA do not match the previously photographed PRN logs with fourteen (14) instances of medication-1 administration having been omitted which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
Licensee to take their required twenty (20) hours of annual training from a vendor approved by Community Care Licensing. Proof of all twenty (20) hours to be submitted to Community Care Licensing by POC due date of 7/13/2026.
Deadline recorded: Jul 13, 2026. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jul 13, 2026
Correction not verified in available records
Complaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations4 substantiated · 0 unsubstantiated · 0 unfounded · 2 cited
Resident rightsType A
- Official classification
- Type A
- Official code
- 87468.2(a)(4)
- Regulation authority
- CCR
What the official deficiency says
87468.2 Additional Personal Rights of Residents... (a) ... residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) to care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met by licensee as evidenced by: Based on LPA interview with licensee and photographic evidence obtained,This requirement was not met by license as evidenced by: LPA interview with licensee indicating R1 fell on to the floor but licesee could not pick R1 up unasssited. R1 waited at least 30 minutes before receiving assistance, which poses a immediate health, safety, and personal rights risk to resident in care.
Official plan of correction
Facility to submit plan to provide adequate staffing such that staff are sufficient in numbers, qualifications, and competency to meet all residents' needs by plan of correction due date during business hours. If plan is found to be adequate by CCL, then facility to then submit LIC500 reflecting that facility has staff sufficient in numbers, qualifications, and competency to meet all residents' needs no later than 11/01/2024. If the plan is not found to be acceptable, licensee will come in to Regional Office for compliance meeting with CCL management.
Deadline recorded: Nov 6, 2024. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Nov 6, 2024
Correction not verified in available records
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(a)
- Regulation authority
- CCR
What the official deficiency says
87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include... procedures for the safety and well-being of residents, employees and visitors. This requirement was not met by license as evidenced by: Facility on-going issue of bed bugs present at facility is known by licensee and LPA obtained photographic evidence, which poses an potential health, safety, and personal rights risk to resident in care.
Official plan of correction
Licensee to ensure facility is free from bed bugs by plan of correction due date. Given that previous spray and steam treatments did not work, licensee agrees to tarp and treat facility with heat and/or perform the service recommened by exterminator E1 or E2 that will be most effective to ensure facility is free from bed bugs. *civil penalty assessed for repeat violation within 12 months*
Deadline recorded: Nov 6, 2024. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Nov 6, 2024
Correction not verified in available records
Complaint
Allegations0 substantiated · 2 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations1 substantiated · 0 unsubstantiated · 0 unfounded · 1 cited
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(a)
- Regulation authority
- CCR
What the official deficiency says
87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include... procedures for the safety and well-being of residents, employees and visitors. This requirement was not met by license as evidenced by: Facility on-going issue of bed bugs present at facility is known by licensee, which poses an immediate health, safety, and personal rights risk to resident in care.
Official plan of correction
Facility to submit work order and paid invoice for bed bug treatment by professional company by plan of correction due date.
Deadline recorded: Oct 10, 2024. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Oct 10, 2024
Correction not verified in available records
Complaint
Allegations0 substantiated · 6 unsubstantiated · 1 unfounded
No deficiencies recorded in this reportComplaint
Allegations3 substantiated · 5 unsubstantiated · 0 unfounded · 4 cited · investigated over 2 visits
No deficiencies recorded in this reportComplaint
Part of the complaint whose outcome is recorded on Oct 20, 2023 · Control 21-AS-20230803103840
Staffing, personnel, and trainingType A
- Official classification
- Type A
- Official code
- 87411(c)
- Regulation authority
- CCR
What the official deficiency says
87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. This requirement was not met based on record reviews showing that staff was not trained per regulation. This is an immediate risk to the Health and Safety of residents in care.
Official plan of correction
Licensee will submit a planned training schedule to LPA that will ensure that staff are trained per regulation no later than POC due date, 10/11/2023.
Deadline recorded: Oct 11, 2023. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Oct 11, 2023
Correction not verified in available records
Facility condition and maintenanceType A
- Official classification
- Type A
- Official code
- 87307(d)(2)
- Regulation authority
- CCR
What the official deficiency says
87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement was not med based on interview and observation showing that facility has insects inside the facility. This is an immediate risk to the health and safety of residents in care.
Official plan of correction
Licensee to send a written plan how they will ensure that there are no insects or rodents in the facility no later that 10/11/2023.
Deadline recorded: Oct 11, 2023. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Oct 11, 2023
Correction not verified in available records
Medication handling and storageType B
- Official classification
- Type B
- Official code
- 87465(h)(5)
- Regulation authority
- CCR
What the official deficiency says
87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: based on observation and interview facility is pre-pouring medication.
Official plan of correction
Licensee to submit self certification that they will no longer be pre-pouring medications by POC due date of 10/16/2023.
Deadline recorded: Oct 16, 2023. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Oct 16, 2023
Correction not verified in available records
Medical and dental careType B
- Official classification
- Type B
- Official code
- 87465(6)
- Regulation authority
- CCR
What the official deficiency says
87465 Incidental Medical and Dental Care (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident... includes: (A)The name of the resident for whom prescribed. (B) The name of the prescribing physician., (C) The drug name, strength and quantity., (D) The date filled., (E) The prescription number and the name of the issuing pharmacy., (F) Instructions, if any, regarding control and custody of the medication.
Official plan of correction
Licensee to audit medications and update centrally stored log so that it is accurate and submit self certification to LPA showing it is completed by POC due date of 10/24/2023.
Deadline recorded: Oct 24, 2023. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Oct 24, 2023
Correction not verified in available records
Complaint
Allegations0 substantiated · 2 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations1 substantiated · 0 unsubstantiated · 0 unfounded · 1 cited
Incident reportingType B
- Official classification
- Type B
- Official code
- 87211(a)(2)
- Regulation authority
- CCR
What the official deficiency says
87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. Requirement was not met based on interviews confirming that 2 residents were diagnosed with Covid-19 and facility did not report to CCL or local public health. This is a potential risk to the health and safety of residents in care.
Official plan of correction
Licensee agrees to review the facility Mitigation Plan with all staff to ensure Covid-19 protocols are being followed and submit proof of training to CCL by POC due date, 10/12/2022.
Deadline recorded: Oct 12, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Oct 12, 2022
Correction not verified in available records
Source and limits
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.
Read the data methodology