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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803541
Report Date: 03/14/2025
Date Signed: 03/14/2025 12:24:02 PM

Document Has Been Signed on 03/14/2025 12:24 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:PEOPLE'S CARE ROLLING HILLSFACILITY NUMBER:
486803541
ADMINISTRATOR/
DIRECTOR:		GARRETT JOHNSONFACILITY TYPE:
735
ADDRESS:4219 ROLLING HILLS LNTELEPHONE:
(707) 447-5317
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 4CENSUS: 4DATE:
03/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Garrett Johnson, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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At approximately 9:25 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year inspection and was greeted by Administrator Garrett Johnson. People's Care Rolling Hills is Licensed as an Adult Residential Facility (ARF). The facility is a Multi-story house. The facility has an approved fire clearance for four (4) ambulatory Clients between the ages of eighteen (18) and fifty-nine (59). Upon arrival, LPA was informed that there were four (4) clients in care. At approximately 9:45 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation.

At approximately 9:50 AM, LPA toured the facility with Administrator Johnson. All exits were clear and unobstructed. All four (4) fire extinguishers were last serviced and tagged on 3/12/2025. Food supply was sufficient. The facility was sufficiently lighted. LPA inspected two (2) client bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Toxins were observed to be stored inaccessible to clients. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 1/14/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to exceed Title 22 regulations of 105 to 120 degrees Fahrenheit. There were warning signs prominently displayed warning that water temperature may exceed 125 degrees Fahrenheit. Waste bins were observed not to have tight fitting covers per regulation. A Technical Assistance Advisory is being issued for waste bins not having tight fitting covers. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational.

Continued on 809-C
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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
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: PEOPLE'S CARE ROLLING HILLS
FACILITY NUMBER: 486803541
VISIT DATE: 03/14/2025
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...Continued from 809

At approximately 10:35 AM, LPA reviewed 3 (three) client files. Three (3) of three (3) client files were found to be well organized and thorough with all required documentation. LPA reviewed three (3) staff files. All staff files were found to be well organized with all required documentation including First Aid and CPR certification, education and proper training documentation. LPA spot checked Medication for two (2) clients. LPA observed all medications to be centrally stored, secure and with proper documentation. Client’s monies for personal and incidental (P&I) items were spot checked and observed to be kept secured and to balance to P&I logs.

Garret Johnson's Administrator Certification 7015248735 is current valid with an expiration date of 5/28/2026.

LPA requested the following documents be submitted to Community Care Licensing by 4/14/2025:

LIC 500 Personnel Report


LIC 308 Designation of Responsibility
LIC 610D Emergency Disaster Plan
Updated Property Lease

No deficiencies cited during today's visit.

Exit interview conducted. Copy of report and Technical Assistance Advisory discussed and provided to Administrator Johnson. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025
LIC809 (FAS) - (06/04)
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