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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496800848
Report Date: 10/21/2022
Date Signed: 12/16/2022 03:06:28 PM


Document Has Been Signed on 12/16/2022 03:06 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: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: 3DATE:
10/21/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee - Rose Wilbor, Administrator - George Wilbor, Administrator - Jeremy Mercado, Staff - Jerez Mercado, and representative Jacob ReinhardtTIME COMPLETED:
10:25 AM
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Regional Manager, Carla Nuti-Martinez, Licensing Program Manager Bethany Moellers, Licensing Program Manager Hope Debenadeti, Licensing Program Manager Kim Mota, , Licensing Program Analyst, Shannan Hansen met vertually on a video conference with Licensee Rose Wilbor, Administrator, George Wilbor, Administrator Jeremy Mercado, and staff Jerez Mercado with their representative Jacob Reinhardt.

This virtual Office Meeting was held to ensure receipt and understanding of the Decision and Order (D&O) (CDSS No. 7222096201C & CDSS No. 7222096201D) with effective date December 16, 2022. The Decision and Order was read during this virtual office meeting.

The Default Decision and Order states in part the following:

Respondent Rosalinda Wilbor's license to operate a residential care facility for the elderly located at 1637 Joan Dr., Petaluma, CA 94954, is revoked.

Respondent Rosalinda Wilbor's license to operate a residential care facility for the elderly located at 1724 Moclips Dr., Petaluma, CA 94954, is revoked.

Respondent George Wilbor's administrator certificate for residential care facilities for the elderly is revoked.

Respondent Jeremy Mercado's administrator certificate for residential care facilities for the elderly is revoked.

Continued on LIC809C
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022
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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: ST. FRANCIS ASSISTED LIVING
FACILITY NUMBER: 496800848
VISIT DATE: 10/21/2022
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Continued from LIC809

Facility to follow regulations issuing eviction notices and providing residents and any responsible parties a copy of the Default Decision and Order.

Participants of the meeting inquired about submitting an application for property owned by Rose Wilber’s, address referenced in the D&O as well as an address located in Santa Rosa. It was advised that the applications would go through our application unit and the RO can not speak to the applications at this time. The Licensee’s counsel engaged and informed he would be able to assist/advise in that process. Participants were informed that the Santa Rosa address would need to have permits cleared by the City/County of all issues pertaining to the property not limited to the septic system.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: ST. FRANCIS ASSISTED LIVING
FACILITY NUMBER: 496800848
VISIT DATE: 10/21/2022
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Fully signed 809 by Dept. & Licensee and Admin George Wilbor on 10/21/2022.

St. Francis Fully Signed LIC 809 Office Meeting 10-21-2022.pdfSt. Francis Fully Signed LIC 809 Office Meeting 10-21-2022.pdf
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC809 (FAS) - (06/04)
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