216801961-1-26-2026-21-AS-EMAO-DQPU3M-20260126141345

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 216801961
Report Date: 01/26/2026
Date Signed: 01/26/2026 02:13:53 PM

Document Has Been Signed on 01/26/2026 02:13 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:	CAREMAX, INC. - QUIETWOOD HOME		FACILITY NUMBER:	216801961
ADMINISTRATOR/ DIRECTOR:	YANG, WEI & LI,JUAN		FACILITY TYPE:	735
ADDRESS:	490 QUIETWOOD DRIVE		TELEPHONE:	(415) 225-6868
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY: 4		CENSUS: 3	DATE:	01/26/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:20 PM
MET WITH:	Willie Yang, Administrator Jocelyn Farreau, House Manager		TIME VISIT/ INSPECTION COMPLETED:	02:30 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	At approximately 12:20 PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection. Administrator Wei "Willie" Yang and House Manager Jocelyn Farreau arrived at approximately 12:35 PM. Staff Jenny Qian from Caremax, inc Administration office arrived shortly after. Facility is an Adult Residential Facility (ARF) with three (3) clients in care. LPA was informed that all clients were away at Day Program. Facility is serviced by vendor Golden Gate Regional Center (GGRC). At approximately 12:40 PM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a two (2) story home, was a comfortable temperature, and passageways were free from obstructions. LPA was informed that second story is used for staff rooms and not accessible to clients. Facility's fire extinguisher was observed charged and last serviced 10/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperatures in client bathrooms read at 105.3 degrees F and 108.5 degrees F which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, and paper products available for clients. Clients' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulation. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two (2) days of perishable food and seven (7) days of non-perishable foods, as well as an emergency water supply. Facility has an internet access devise and internet available to clients in care, and the phone was tested and operational during today's inspection. There is a shaded seating area in the backyard with outdoor space for activities. Facility stores additional supplies including emergency food and seasonal decorations in outer room. Continued LIC809C...

NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Elias Magdaleno
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

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: CAREMAX, INC. - QUIETWOOD HOME	FACILITY NUMBER: 216801961
	VISIT DATE: 01/26/2026

NARRATIVE

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Continued from LIC809...

Facility conducts monthly disaster drills, and the most recent drill was conducted 1/26. LPA observed facility's infection control plan and emergency disaster plan which was last updated 1/26. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. Client expenses are documented and up to date, staff purchase items requested by clients and are reimbursed through client held bank accounts. Receipts were signed off and recorded, client personnel records were signed off and recorded.

At approximately 1:05 PM LPA conducted a review of three (3) client records. All required documentation present.

At approximately 1:10 PM LPA conducted review of three (3) staff records. All required documentation present.

At approximately 1:35 PM LPA and House Manager conducted a spot check of medication and medication records. Medication is centrally stored and locked.

Administrator Certificate for Wei Yang certificate number 7032604735 expires 10/16/2027.

Updated copies of the following documents were gathered during this visit:
LIC500 - Personnel Report
LIC308 - Designation of Responsibility
LIC610D - Emergency Disaster Plan
LIC400 - Affidavit Regarding Client Cash Resources

No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.

NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Elias Magdaleno
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC809 (FAS) - (06/04)

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