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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496800848
Report Date: 07/13/2021
Date Signed: 07/16/2021 10:05:36 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ST. FRANCIS ASSISTED LIVINGFACILITY NUMBER:
496800848
ADMINISTRATOR:MERCADO, JEREMYFACILITY TYPE:
740
ADDRESS:1637 JOAN DRIVETELEPHONE:
(707) 789-9260
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY:6CENSUS: 0DATE:
07/13/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rose Wilbor - LicenseeTIME COMPLETED:
03:45 PM
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A virtual Teams call was held today with Regional Manager Carla N. Martinez, Licensing Program Manager; Licensing Program Manager Bethany Moellers; Licensing Program Analyst Carla Fernandes-Goes; Licensee Rose Wilbor, Licensee Marilyn Green, Jerez Mercado and Jeremy Mercado. The discussion was regarding the change of ownership of the St. Francis facilities from an individual licensee to a corporate licensee with Jerez Mercado, Rose Wilbor and Jeremy Mercado being on the corporate board. The application are ready but pending submission due to a fingerprint exemption needed for one of the applicants.

We also discussed the closure of St. Michael’s RCFE which is licensed by Marilyn Green. Rose Wilbor would like to submit for a Change of Ownership and become the Administrator on record under the current Licensee (Marilyn Green) until their application is approved. At this time an application has not been submitted for change of ownership and the current Licensee Marilyn Green wishes to close the facility. Per Jerez Mercado, Rose, Jerez and Jeremy were assisting the Licensee of St. Michael’s and collecting the July rent from the residents. Jerez, Rose and Jeremy were advised this is not allowable. RO reminded participants of the call that the license is NOT TRANSFERABLE. Licensee Marilyn Green and her Administrator is responsible for the operation of St. Michael’s, the care of the residents and collection of rent.


There were no deficiencies cited at this time.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Carla Fernandes-GoesTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021
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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