486801556-3-24-2026-21-AS-SSTN-DSGTPN-20260324145438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 486801556
Report Date: 03/24/2026
Date Signed: 03/24/2026 02:55:04 PM

Document Has Been Signed on 03/24/2026 02:55 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:	ALL SEASONS CARE HOME		FACILITY NUMBER:	486801556
ADMINISTRATOR/ DIRECTOR:	GARCIA, PERLA V.		FACILITY TYPE:	735
ADDRESS:	993 BUTTERNUT CT.		TELEPHONE:	(707) 416-3862
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY: 4		CENSUS: 4	DATE:	03/24/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:15 PM
MET WITH:	House Manager Susana Quisquino		TIME VISIT/ INSPECTION COMPLETED:	03:10 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 12:15 PM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by House Manager, Susana Quisquino who has Designation of Facility Responsibility (RP) RP contacted Administrator/Licensee Perla Garcia to advise of today's inspection. Licensee gave permission for House Manager to assist with today's inspection. Facility is an Adult Residential Care Facility with Developmentally Disabled Clients in care. LPA was informed that all four clients were away at their day programs. At approximately 12:30 PM, LPA initiated a tour of the facility and observed the following: Facility was a comfortable temperature and passageways were free from obstructions and the home was without odors. Water temperature in clients' bathrooms measured within allowable range of 105 to 120 degrees F per regulation. LPA observed a supply of clean linens available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Facility has at least two days of perishable and one week of non-perishable foods. The facility has a large battery wall for back up emergency power and there is outdoor sun and shade space for activities, and the facility plans weekly outings. Food was observed to be properly stored in air tight containers and labeled with the date they are placed in storage. Toxins and sharps that could pose a risk to clients in care were observed to be safely secured. Continued on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

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 3

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)

Page: 2 of 3

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: ALL SEASONS CARE HOME	FACILITY NUMBER: 486801556
	VISIT DATE: 03/24/2026

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
26
27
28
29
30
31
32

Continued from LIC809
The facility is hardwired. Fire extinguisher was last serviced April 2025 and was fully charged. Smoke and Carbon Monoxide detectors were tested and operational during inspection.

Facility knows that Emergency/Disaster drills are held at a minimum of every three (3) months and the facilities last emergency drill was 01/10/2026.

At approximately 1:00 PM Five (5) staff records were reviewed and 5 of 5 had all required documentation.

At approximately 1:30 PM four (4) client records were reviewed and four of (4) clients had all required documentation per title 22 regulation. Facility is asked to update client one (C1's) Appraisal Needs and Service to indicate if C1 continues to self administer injectable insulin or not, to match C1's latest Physician physical.

At approximately 2:00 PM medicines were observed to be centrally stored and secure.

At approximately 2:10 PM P&I money was observed to be secure and the administration accurate.
It was recommended that licensee submit an updated LIC400 Affidavit for Client Cash Resources more in line with the Surety Bond they pay for to ensure easier compliance. A conversation was had with the licensee via phone advising that she could have a larger sum Affidavit.

Licensee to send to CCL by 04/23/2025 by email or Fax the following:
1)LIC500 Personal Report (updated)
2)LIC9020 Registration of current facility clients (If changes)
3)LIC308 Designation of Facility responsibility (if changes)
4)LIC610D Emergency Plan (updated)
5)Updated LIC400 Affidavit of Client Cash Resources that is more in line with the larger Surety Bond insurance the facility now carries.

No deficiencies are cited.
Report reviewed with House Manager Susana Quisquino whose signature here denotes receipt.

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

LIC809 (FAS) - (06/04)

Page: 3 of 3