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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803637
Report Date: 05/04/2026
Date Signed: 05/04/2026 02:45:09 PM

Document Has Been Signed on 05/04/2026 02:45 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:ROSEWOOD CRISIS RESIDENTIALFACILITY NUMBER:
486803637
ADMINISTRATOR/
DIRECTOR:		MINIX, TAMIFACILITY TYPE:
772
ADDRESS:508 ALABAMA STREETTELEPHONE:
(510) 415-4672
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 16CENSUS: 10DATE:
05/04/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Administrator, Tami MinixTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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05/04/2026, Licensing Program Analyst (LPA) Loera arrived unannounced to conduct a Case Management - Incident visit and met with Administrator, Tami Minix. The purpose of the visit was to follow up on self-reported SOC341 that was submitted to Community Care Licensing (CCL).

CCL received an SOC341 on 04/09/2026 involving client (C1) and individual (I1). SOC341 indicates suspected physical abuse between C1 and I1. SOC341 indicates staff observed C1 sitting on the edge of their bed, visibly distressed and crying heavily. C1 initially attributed their distress to "relationship issues" to which staff observed significant swelling and discoloration (bluish and purplish) around the right eye, which was nearly swollen shut, C1 claimed the injury from rubbing their eye after applying makeup. Staff instructed C1 to check in with nurse on site, who stated "that's a black eye". Later that day C1 informed their family member they sustained their injury as a result of being hit by another client.

Per conversation with Administrator, when they overheard that C1 was hit by another client (C2). Facility did not interview C2. Administrator stated they reviewed video security footage from the night of 04/05/2026 and footage revealed C1 allowed a former client (I1) to enter the facility and goes under the facilities deck with C1, that is out of camera view. I1 appeared not to leave the facility in the security footage. Administrator suspects the incident occurred under the deck. C1 and C2 have both been discharged from the facility. C1 was discharged on 4/9/2026 and C2 was discharged a few days after C1. Administrator notified APS and CCL. Administrator did not notify local law enforcement because they simply did not think to. LPA suggested to Administrator in the future if they suspect physical abuse to notify local law enforcement right away. Administrator stated they understand.

Regulation 80061, Reporting Requirements was provided to Administrator.

Exit interview conducted with Administrator and a copy of report was provided.
NAME OF LICENSING PROGRAM MANAGER: Kimberley Mota
NAME OF LICENSING PROGRAM ANALYST: Anthony Loera
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2026
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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