<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803790
Report Date: 11/08/2024
Date Signed: 11/08/2024 04:10:34 PM

Document Has Been Signed on 11/08/2024 04:10 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ROSE HAVEN LLCFACILITY NUMBER:
286803790
ADMINISTRATOR/
DIRECTOR:		FRANCO, RHONFACILITY TYPE:
740
ADDRESS:520 SANITARIUM RDTELEPHONE:
(707) 963-3748
CITY:ST HELENASTATE: CAZIP CODE:
94574
CAPACITY: 32TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/08/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Suresh Mahawar and Rose MahawarTIME VISIT/
INSPECTION COMPLETED:
04:15 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
Regional Manager, Carla Nuti-Martinez, Licensing Program Manager Victoria Bertozzi, Licensing Program Analyst Chris Arnhold met with Licensee Suresh Mahawar and Rose Mahawar to conduct a Non-Compliance Conference.
Licensee was aware since 2023 of fire system issues that required repair, your failure to make those repairs caused you to lose your fire clearance permanently. Residents, including one on hospice were required to be moved. The Department cannot license a facility without a fire clearance, there is an administrative action pending. Should the Fire Clearance be granted in the future, the facility shall not repopulate until the Department conducts an inspection.
Bethany MoellersTELEPHONE: (707) 588-5040
Christopher ArnholdTELEPHONE: (707) 588-5084
DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1