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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 280109377
Report Date: 08/11/2026
Date Signed: 08/11/2026 04:44:19 PM

Document Has Been Signed on 08/11/2026 04:44 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:VETERANS HOME OF CALIFORNIA TRUMAN HALLFACILITY NUMBER:
280109377
ADMINISTRATOR/
DIRECTOR:		THERESA JONESFACILITY TYPE:
740
ADDRESS:300 CALIFORNIA DRTELEPHONE:
(707) 944-4884
CITY:YOUNTVILLESTATE: CAZIP CODE:
94599
CAPACITY: 48CENSUS: 19DATE:
08/11/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Theresa Jones, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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At approximately 10:15 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and met with Theresa Jones, Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) with nineteen (19) residents in care, all of whom are assisted living residents. Facility has a Hospice waiver for four (4).

At approximately 11:15 AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a three story building with all assisted living residents on the main floor. Facility has an evacuation chair placed a the top of the main stairwell. Facility was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in regulation. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed a staff member with two clear spray bottles: one unmarked with a pink liquid inside, and the other with a yellowish colored solution in it and hand written sticker/label reading "use this for table, couch, etc", (see LIC809D). LPA was informed by staff that one solution is a floor cleaner and the other is a furniture cleaner. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There are shaded seating areas throughout the campus with outdoor space for activities. LPA observed residents in common areas watching TV, visiting with people outside, engaged in puzzles and painting activities, or eating in the dining hall. Residents go to the Member Services building for activities and to use the library and computers.

Continued on LIC809-C...
Bethany Moellers
Julie Florio
DATE: 08/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2026
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: VETERANS HOME OF CALIFORNIA TRUMAN HALL
FACILITY NUMBER: 280109377
VISIT DATE: 08/11/2026
NARRATIVE
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Continued from LIC809...

Additionally, residents go to the main dining hall for their meals but snacks are made available in the Day Room and Deputy Office around the clock. However, LPA observed the snack basket empty and no snacks immediately available to residents in care. Administrator asked staff to refill the basket immediately and agreed to have snacks accessible and available to residents in care.

Smoke and carbon monoxide detectors, sprinklers, and fire alarm were tested during the facilities fire inspection dated 09/2025. Fire extinguishers were observed fully charged and were last inspected 02/2026. Emergency Disaster Plan was reviewed and updated 03/2026. Administrator stated that facility conducts emergency disaster drills bi-monthly (six times per year). However, facility was only able to provide LPA with proof of a single drill completed on the a.m. shift only in 03/2026, (see LIC809D). LPA informed Administrator that drills shall be conducted no less than quarterly on every shift in order to operate in compliance with regulation. Facility is quipped with an emergency lighting system and has a supply of flash lights. Facility's first aid cart was inspected and is stocked with the required items per regulation.

At approximately 12:15 PM, LPA conducted file review of five (5) resident files. Five (5) of Five (5) resident files reviewed were observed to contain all of the required documentation.

At approximately 1:30 PM, LPA conducted file review of six (6) staff files. Six (6) of six (6) staff files reviewed were observed to contain all of the required documentation and proof of annual training, annual medication training, and current CPR and FA certifications.

At approximately 3:00 PM, LPA conducted a review of medication and medication records where start dates were not documented for some medications and one medication was observed not recorded onto the centrally stored medication and destruction log for a resident who just returned to facility from the campus skilled nursing facility. Administrator and nursing staff agreed to conduct an all medication technician staff training on the proper intake an documentation of medications immediately to ensure the facility is operating in compliance with regulation moving forward. LPA otherwise observed medications stored and maintained in compliance with regulation.

Continued on LIC809C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Julie Florio
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026
LIC809 (FAS) - (06/04)
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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: VETERANS HOME OF CALIFORNIA TRUMAN HALL
FACILITY NUMBER: 280109377
VISIT DATE: 08/11/2026
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Continued from LIC809C...

Administrator states that the residents, the medical records department, and the Ambulatory Care Clinic (ACC) coordinate medical and dental appointments as well as transportation to and from appointments when residents have the need.

Facility does not maintain or manage P&I cash resources for residents.

Deficiencies are being cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the deficiencies by the plan of correction date and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted with Administrator whose signature on form confirms receipt of documents. Appeal rights provided.

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Julie Florio
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/11/2026 04:44 PM - It Cannot Be Edited


Created By: Julie Florio On 08/11/2026 at 04:13 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: VETERANS HOME OF CALIFORNIA TRUMAN HALL
FACILITY NUMBER: 280109377

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87309(a)(2)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. (2) Any items in subsection (a)(1) that are transferred from their original container to another container shall have a legible label that indicates:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in ensuring that cleaning solutions transferred from their original container to another container have the required labeling as staff were observed using to bottles not labeled per regulation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/11/2026
Plan of Correction
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Administrator to submit proof of training with all staff reviewing the above regulation to CCL by POC due date 09/11/2026.
Type B
Section Cited
HSC
1569.695(c)
Other Provisions
(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
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Based on record review, the licensee did not comply with the section cited above in ensuring that the required disaster drill is conducted on each shift no less than quarterly which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/11/2026
Plan of Correction
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Administrator to conduct a required disaster drill on all shifts and submit it along with a self certification that facility understands that drills shall be conducted on every shift no less than quarterly to CCL by POC due date 09/11/2026.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Julie Florio
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2026


LIC809 (FAS) - (06/04)
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