486803243-2-24-2026-21-AS-SSTN-DRLRU8-20260224121930

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 486803243
Report Date: 02/24/2026
Date Signed: 02/24/2026 12:19:42 PM

Document Has Been Signed on 02/24/2026 12:19 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:	CAREBEST		FACILITY NUMBER:	486803243
ADMINISTRATOR/ DIRECTOR:	ZHANG, GUOLIAN		FACILITY TYPE:	735
ADDRESS:	2376 BURGUNDY WAY		TELEPHONE:	(707) 427-8776
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY: 4		CENSUS: 3	DATE:	02/24/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:			TIME VISIT/ INSPECTION COMPLETED:	12:35 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 9:45 AM, Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a Required 1 Year inspection and met with Staff Member, Rongmin Xu who has Designation of Facility Responsibility (RP) RP placed a call to licensee/administrator Guolian "Mark" Zhang to advise of today's required inspection. Licensee arrived at approximately 10:30 AM with additional employee and client documents and Licensee was issued a Technical Violation of CCR80066(e) which requires complete staff and client records to be kept at the facility at all times. Licensee advised to set up a locking storage area with access for his staff if he felt information like health records and social security numbers were to sensitive to keep on site. Facility is an Adult Residential Facility. Facility has an approved fire clearance and capacity for 1 ambulatory and 3 non-ambulatory clients per fire inspection on 06/17/2010. Licensee currently prefers to care for 3 clients at a time, all who were home during my inspection. LPA notes that all three (3) clients are physically able to walk about the facility. At approximately 10:30 AM, LPA conducted a tour with licensee and observed the following: Facility is a 1 story building with 1 double client bedroom and two single client bedrooms, 2 staff rooms, office space and common spaces. Facility was found to be at a comfortable temperature, without odors with all exits free from obstruction. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Water accessible to clients in care were between 105F and 120F as required by title 22 regulations. Continued on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026

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 5

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 5

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: CAREBEST	FACILITY NUMBER: 486803243
	VISIT DATE: 02/24/2026

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 form LIC 809
Foods out of their original commercial packaging were noted by be in airtight bags and containers and labeled with the date of storage this year. No expired canned foods were observed in garage pantry.

Toxins and sharps were observed to be stored inaccessible to clients. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Bathrooms were equipped with necessary furniture. Grab bars, and non-slip floors/mats were present. Mattress pads were in place or available for client use.

A backyard shed was unlocked to reveal hardware supplies and additional care goods. Licensee was reminded to cut high green grasses before they dry in the spring to reduce fire hazard.

At approximately 10:55 AM, Three (3) of 3 Staff files were all found to have all required documentation. Staff have current first aid/CPR certification.

At approximately 11:20 AM, Three (3) of three (3) client files were found to have all required documentation except each of 3 clients were missing a Signed Consent For Emergency Medical Treatment (LIC627C) signed by each clients responsible party or conservator and a Technical Advisory for CCR 80070(a) was issued.
Medication was observed to be centrally stored and secure and their administration accurate.

P&I monies were found secure, correctly accounted for and just under the facilities Affidavit for Client Cash Resources.

Facility's last emergency/disaster drill was February 2025. Facility's fire system was last inspected January 2025. Fire Extinguisher was observed to be fully charged and last inspected on 04/2025

LPA requested the following documents to update facility file be submitted to licensing by 03/22/2026
· Current Designation of Facility Responsibility (LIC 308)
· Emergency Disaster Plan (LIC 610D)
· Updated Personnel Report (LIC 500)

Technical Violations and Advisories are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies) may result in a civil penalty assessment.

This report was reviewed with Guolian "Mark" Zhang and Appeal rights were given

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026

LIC809 (FAS) - (06/04)

Page: 3 of 5