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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804363
Report Date: 05/18/2026
Date Signed: 05/18/2026 01:28:54 PM

Document Has Been Signed on 05/18/2026 01:28 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:CARINGHANDS HILLVIEWFACILITY NUMBER:
486804363
ADMINISTRATOR/
DIRECTOR:		SINGERMAN, IZAHFACILITY TYPE:
740
ADDRESS:141 HILLVIEW DRIVETELEPHONE:
(707) 645-9476
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 6CENSUS: 5DATE:
05/18/2026
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Izah Singerman (Administrator)TIME VISIT/
INSPECTION COMPLETED:
01:43 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Post-Licensing inspection and was greeted by individual (I1) who introduced themselves as Administrator, but they are not associated to the facility, Administrator, Izah Singerman arrived later. The facility does have residents with diagnosis of dementia, but there are no hospice waiver on file. Administrator reached out to centralized application bureau (CAB) to address hospice waiver application for six residents. Required postings were observed.

LPA informed administrator that I1 is not associated to facility and should never be working and providing care to residents prior to a criminal record transfer clearance or exemption. Civil penalties are being assessed in the amount of $100 for allowing a person to work, reside or volunteer in the facility without a fingerprint clearance exemption. The facility had a change of ownership back in March, the facility received an approved fire clearance dated 10/01/2025 that allows for a total capacity of five (5) non ambulatory and one (1) bedridden. Facility is a one story building with a total of five residents bedrooms, which bedroom #5 is a shared room and other four rooms are single occupancy rooms, room #3 bedridden room, three full bathrooms, caregiver's room, laundry area, office, garage, kitchen, dining room, living room as common areas. LPA/Administrator conducted a tour and inspection of the indoor and outdoor portions of the facility. During tour of the facility LPA/Administrator observed hoyer lift in room#2 and night stand in room #5 were blocking identified exits through the patio. Facility was found to be clean and comfortable temperature. LPA observed fire extinguishers to be last charged March 2026. All eight auditory alarms were functional. Facility's carbon monoxide/smoke detectors located throughout the facility are synchronized and were tested and operational. Bathrooms had appropriate grab bars and slip resistant mats. The facility needs to increase the amount of emergency food and water for 72 hours in case of an emergency. Facility has a storage shed located in the backyard that was found to be inaccessible to residents in care. Facility has first aid kit which was found to be appropriate during the Post-Licensing inspection. Continued on LIC809C...

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Marisol Cuadra
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2026
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 14
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 14
Document Has Been Signed on 05/18/2026 01:28 PM - It Cannot Be Edited


Created By: Marisol Cuadra On 05/18/2026 at 12:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CARINGHANDS HILLVIEW
FACILITY NUMBER: 486804363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(3)
Maintenance and Operation
(3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's/Administrator observations, the temperature reading of hot water facets not used by residents, the kitchen sink facet reading was 132.4, 134.8 and 125.8 in the bathrooms which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/19/2026
Plan of Correction
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Administrator agrees to place warning signs for faucets delivering water 125 or above. Administrator immediately adjusted water heater. To clear this violation, Administrator will submit photo proof of each faucet identified in this report with a warning sign placed near the faucet to warn the user of the hot water temperature. Photos to be submitted to CCL by POC date by 5/19/26.
Type A
Section Cited
CCR
87355(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's/Administrator observations, record review and interviews, the licensee did not comply with the section cited above in that one caregiver (I1) was not associated with the facility in Guardian which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/19/2026
Plan of Correction
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Administrator agrees to associate I1 in the Guardian system and submit proof of doing so by POC due date of 5/19/2026. *Civil penalties are been assessed in the amount of $100 for having a person who was not associated to the facility work with residents in care.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Marisol Cuadra
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2026


LIC809 (FAS) - (06/04)
Page: 3 of 14
Document Has Been Signed on 05/18/2026 01:28 PM - It Cannot Be Edited


Created By: Marisol Cuadra On 05/18/2026 at 12:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CARINGHANDS HILLVIEW
FACILITY NUMBER: 486804363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87211(a)(1)
Reporting Requirements
(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observations, record review and interviews, administrator failed to report incidents that threatened the safety or health of residents, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2026
Plan of Correction
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Administrator to ensure incidents are reported per regulation. Administrator to review regulation 87211, which was provided, and conduct training for all staff on reporting requirements. Evidence of completed training to be submitted to CCL by POC date of 06/01/2026.
Type B
Section Cited
CCR
87307(d)(6)
Personal Accommodations and Services
(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's/administrator observation, records review of facility sketch and interviews with administrator, the facility staff did not ensure that resident's night stand and hoyer lift were blocking an identified exit leading from bedrooms to the patio which poses a potential risk to the health and safety of residents in care.
POC Due Date: 06/01/2026
Plan of Correction
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Administrator agrees to keep all passageways free from obstruction. Administrator moved night stand and hoyer lift machine away from exit doors allowing passage. Administrator agrees to review regulation and conduct staff training with all staff, then administrator will submit LIC9098 certifying that the passageway will be kept cleared at all times by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Marisol Cuadra
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2026


LIC809 (FAS) - (06/04)
Page: 4 of 14
Document Has Been Signed on 05/18/2026 01:28 PM - It Cannot Be Edited


Created By: Marisol Cuadra On 05/18/2026 at 12:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CARINGHANDS HILLVIEW
FACILITY NUMBER: 486804363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87309(a)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's/Administrator observation and interview, the licensee did not comply with the section cited above by having toxins and cleaning supplies were unlocked under the kitchen sink which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2026
Plan of Correction
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Administrator agrees to conduct an all staff training to review regulation and items to be stored inaccessible, submit training roster and topics covered to CCL by POC 06/01/2026.
Type B
Section Cited
HSC
1569.618(c)(3)
Other Provisions
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's/administrator records review and interview, the licensee failed to have at least staff member who has CPR and 1st Aid training on duty at all times. Facility has one out of three caregivers (S2) that work at the facility without a valid CPR certificate which poses a potential health, safety risk to residents in care.
POC Due Date: 06/01/2026
Plan of Correction
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Administrator to ensure that at least one staff on duty has CPR training at all times & all staff have First Aid. Administrator to submit self-certification form (LIC9098) ensuring that staff (S2) have current CPR trained per regulation by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Marisol Cuadra
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2026


LIC809 (FAS) - (06/04)
Page: 5 of 14
Document Has Been Signed on 05/18/2026 01:28 PM - It Cannot Be Edited


Created By: Marisol Cuadra On 05/18/2026 at 12:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CARINGHANDS HILLVIEW
FACILITY NUMBER: 486804363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)(11)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's/administrator observation, interviews and record review, the licensee did not comply with the section cited above in that 3 out of 3 staff (S1, S2 & S3) did not have Heatth Screens including TB tes on file, which poses a potential health, safety or personal rights risk to persons in care. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2026
Plan of Correction
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Administrator to ensure staff have health screening including TB test done and shall submit self-certification (LIC9098) they have obtained health screening for all three staff (S1, S2 & S3) including TB test. Self-certification shall be submitted to CCLD by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Marisol Cuadra
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2026


LIC809 (FAS) - (06/04)
Page: 6 of 14
Document Has Been Signed on 05/18/2026 01:28 PM - It Cannot Be Edited


Created By: Marisol Cuadra On 05/18/2026 at 12:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CARINGHANDS HILLVIEW
FACILITY NUMBER: 486804363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(b)(1)
Other Provisions
(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's/administrator observation, interview and record review, the licensee did not comply with the section cited above in three out of three staff there was no proof of staff having obtained required annual direct care staff training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2026
Plan of Correction
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Administrator to ensure that all staff (S1, S2 & S3) obtain required annual training for direct care staff. Administrator shall submit self-certification (LIC9098) they have obtained required annual training hours. Self-certification shall be submitted to CCLD by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Marisol Cuadra
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2026


LIC809 (FAS) - (06/04)
Page: 7 of 14
Document Has Been Signed on 05/18/2026 01:28 PM - It Cannot Be Edited


Created By: Marisol Cuadra On 05/18/2026 at 12:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CARINGHANDS HILLVIEW
FACILITY NUMBER: 486804363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87555(b)(26)
General Food Service Requirements
(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's/administrator observation and interview, the licensee did not comply with the section cited above by having one orange and cantaloupe as only fruits for five residents in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2026
Plan of Correction
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Administrator shall submit self-certification (LIC9098) ensuring they have obtained adequate supplies of fresh fruits and vegatables for at least two days for residents in care. Self-certification shall be submitted to CCLD by POC due date.
Type B
Section Cited
CCR
87463(a)
Reappraisals
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on LPA's/administrator observation, interview and record review, the licensee did not comply with the section cited above in one out of two out of five residents (R2 & R3) care plans wwere not completed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2026
Plan of Correction
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Administrator shall submit self-certification (LIC9098) they have completed required care plans for R2 & R3. Self-certification shall be submitted to CCLD by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Marisol Cuadra
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2026


LIC809 (FAS) - (06/04)
Page: 8 of 14
Document Has Been Signed on 05/18/2026 01:28 PM - It Cannot Be Edited


Created By: Marisol Cuadra On 05/18/2026 at 12:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CARINGHANDS HILLVIEW
FACILITY NUMBER: 486804363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.695(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on file review and interview, the facility failed to conduct an emergency drill within the past quarter which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2026
Plan of Correction
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Administrator agrees to conduct and document disaster drills every 3 months on all shifts with all direct care staff. Licensee agrees to conduct a disaster drill on all shifts with all direct care staff and submit self-certification (LIC9098) form to CCL by POC 6/1/2026.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Marisol Cuadra
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2026


LIC809 (FAS) - (06/04)
Page: 9 of 14
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CARINGHANDS HILLVIEW
FACILITY NUMBER: 486804363
VISIT DATE: 05/18/2026
NARRATIVE
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Continued from LIC809...
-At approximately 9:30am, LPA/Administrator observed that there was no record on file when was the last disaster drill was conducted at the facility.
-At approximately 9:40am, LPA/Administrator observed toxins and cleaning supplies were unlocked under the kitchen sink.
-At approximately 9:45am, LPA/Administrator measured water temperature at 132.4, 134.8 and 125.8 which are not within regulation between 105 & 120 degrees F, there were no warning signs about faucet dispensing hot water. The Administrator adjusted water heater immediately.
-At approximately 9:50am, LPA/Administrator observed limited amount of two-day supply of perishable but adequate supply of seven day non-perishable food.
All resident’s bedrooms have lighting & appropriate furnishings, and resident’s beds were outfitted with mattress pads as required by Title 22 Regulations. Resident records, personnel records and medication were locked and inaccessible to resident's in care in a locked cabinet located in the office. Refrigerated food was found to be stored in a safe manner being labeled and dated. A supply of hygiene products were observed. The facility does not have a generator (technical violation issued). Also, garbage cans did not have a tight fitting covers for all bedrooms (technical violation issued). Medication and medication records reviewed.
LPA initiated file review at 10:00am. Three staff files and five resident's file were reviewed. All residents have updated medical assessment, but two out of five residents (R2 & R3) needs care plans. As of today, four out of five residents have not been provided with an admission agreement addendum identifying the change of ownership (technical violation issued). Also, Residents (R1, R2, R3) doesn't have half bed rails doctor's order on file (technical violation issued). During file review, LPA/Administrator observed residents (R1 & R2) had a hospitalization, but they were not reported to CCL. One out of three staff (S2) needs to have required CPR/1st aid certificate and three out of three staff (S1, S2 & S3) needs to have initial training 40 hours complete and health screening including TB test. Administrator certificate for administrator Izah Singerman #7023098740 expires on 09/03/2026. The Administrator agreed to submit updates of the following documents by 06/01/26: LIC500 Personnel Report, LIC308 Designation of Responsibility & liability insurance.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Civil penalties are being assessed in the amount of $100 for allowing a person to work, reside or volunteer in the facility without a fingerprint clearance exemption. Exit interview was conducted, and a copy of this report was signed and given to the Administrator.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Marisol Cuadra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
LIC809 (FAS) - (06/04)
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