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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216804066
Report Date: 09/04/2024
Date Signed: 09/04/2024 04:02:12 PM


Document Has Been Signed on 09/04/2024 04:02 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:BLUFFS AT HAMILTON HILL, THEFACILITY NUMBER:
216804066
ADMINISTRATOR:MUOZ, DENISEFACILITY TYPE:
740
ADDRESS:1 HAMILTON HILL DRIVETELEPHONE:
(415) 889-8026
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:95CENSUS: 69DATE:
09/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Business Manager, Karina VasquezTIME COMPLETED:
04:15 PM
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09/04/2024, Licensing Program Analysts (LPA) Loera and Felias conducted an unannounced Annual Required – 1 yr. inspection visit for this facility and met with Business Office Manager, Karina Vasquez. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently 69 residents in care. Facility approved/cleared for 95 non-ambulatory and 14 bedridden.

LPAs arrived at approximately at 2:00pm and observed that the facility's fire alarm was active. LPAs observed facility following their emergency disaster plan appropriately.

LPAs met with Business Manager, Karina Vasquez, at approximately 2:45PM who notified LPAs that it was a false fire alarm. LPAs requested for incident report.

At approximately 3:15pm, LPAs reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation.

LPAs also requested for Administrator Paperwork to be submitted to Community Care Licensing (CCL) to process Lisa Lomeli as the new Executive Director/Administrator for the facility. LPAs received notice that Lisa Lomeli was to be the new Administrator on 08/08/2024. LPAs received copies of requested paperwork during visit.

LPAs unable to complete the Annual Inspection. Annual Continuation Visit to be conducted at a later date.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report discussed and provided to Business Manager. Signature on form confirms receipt of documents.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5071
LICENSING EVALUATOR NAME: Anthony LoeraTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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