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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803823
Report Date: 04/09/2026
Date Signed: 04/09/2026 04:19:48 PM

Document Has Been Signed on 04/09/2026 04:19 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:LIGAYA DAY SERVICESFACILITY NUMBER:
216803823
ADMINISTRATOR/
DIRECTOR:		LUCERO, MARIBETHFACILITY TYPE:
775
ADDRESS:70 SAN PABLO AVETELEPHONE:
(415) 785-3996
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 30CENSUS: 25DATE:
04/09/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Administrator, Reggie Catiis, Program Supervisor, Ilse Resendiz, and Assistant Director, Erika De VeraTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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At approximately 11:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Case Management - Deficiencies visit, and met with Administrator, Reggie Catiis, Program Supervisor, Ilse Resendiz, and Assistant Director, Erika De Vera.

During the course of Complaint Investigation, Control Number 21-AS-20260112152456, the following deficiencies were identified:
  • Facility did not report to Community Care Licensing (CCL) in an LIC624 or SOC341 regarding C1 and concerns of alleged bruising.
  • Facility did not follow C1's ISP dated 03/04/2024. Review of C1's ISP stated that C1 should have a minimum of 45 minutes dedicated to getting them prepared for transportation. Per interviews conducted facility staff stated that when C1 is not wanting to get on the bus they are given some time and are told that their friends are on the bus or that their family is waiting for them. C1 is also given 5 -10 minutes and a countdown.
  • Facility did not ensure C1's personal rights. Facility narrative forms found in C1's file stated that facility staff picked C1 up by their waist and by their feet to place them on the transportation bus on 01/06/2026. Review of C1's nursing needs assessment dated 05/03/2021 stated that C1 is ambulatory and is able to walk.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.
NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Caitlynn Felias
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2026
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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Document Has Been Signed on 04/09/2026 04:19 PM - It Cannot Be Edited


Created By: Caitlynn Felias On 04/09/2026 at 02:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LIGAYA DAY SERVICES
FACILITY NUMBER: 216803823

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/20/2026
Section Cited
CCR
82061(a)

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82061 Reporting Requirements (a) Upon the occurrence...any of the events specified in Section 82061(a)(1)...a written report...shall be submitted to the licensing agency within seven days following the occurrence of the event. This requirement has not been met as evidenced by: based on record review and
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Licensee to conduct in-service training on 82061 Reporting Requirements and to submit a report for the incident that occurred on 01/05/2026 to CCL as part of the plan of correction. In-service training to include the following: Date, Topic, Job Role, Staff Names, and Signatures. Proof of in-service
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observations made, Licensee did not comply with the section cited above and did not ensure that a report/LIC624 was submitted to CCL after becoming aware of alleged bruising on C1. This is a potential health, safety, or personal rights risk to clients in care.
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training and incident report to be submitted by POC due date of 04/20/2026.
Type B
04/20/2026
Section Cited
CCR82072(a)(3)

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82072 Personal Rights:(a)Each client shall have personal rights which include, but are not limited to, the following:(3)To be free from... humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature...This requirement was not met as evidenced by:
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Licensee to conduct in-service training on 82072 Personal Rights. Proof of in-service training to include the following: Date, Topic, Job Role, Staff Names, and Signatures by POC due date of 04/20/2026.
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based on record review & observations made, Licensee did not comply with the section cited above & did not ensure C1's personal rights. C1 was lifted onto the bus by their waist and feet when C1 is able to walk. This is a potential health/safety/personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Victoria Bertozzi
NAME OF LICENSING PROGRAM MANAGER:
Caitlynn Felias
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/09/2026 04:19 PM - It Cannot Be Edited


Created By: Caitlynn Felias On 04/09/2026 at 02:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LIGAYA DAY SERVICES
FACILITY NUMBER: 216803823

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/20/2026
Section Cited
CCR
82078(a)

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82078 Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement. This requirement was not met as evidenced by: based on record review, interviews, and observations made
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Licensee to contact Regional Center and Responsible Party to discuss interventions on how to manage C1's behavior. Licensee to conduct an in-service training to ensure facility staff receive appropriate strategies for C1's behavior. Licensee to update CCL on when meeting will be scheduled by POC due
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Licensee did not comply with the section cited above. Licensee did not ensure that C1's ISP was followed. This is a health, safety, or personal rights risk to clients in care.
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date of 04/20/2026. Proof of meeting notes and in-service training on appropriate strategies to be submitted to CCL by 05/09/2026. In-service training to include the following: Date, Topic, Job Role, Staff Names, and Signatures.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Victoria Bertozzi
NAME OF LICENSING PROGRAM MANAGER:
Caitlynn Felias
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2026


LIC809 (FAS) - (06/04)
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