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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803537
Report Date: 03/27/2025
Date Signed: 03/27/2025 03:35:04 PM

Document Has Been Signed on 03/27/2025 03:35 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:KENWOOD GREENSFACILITY NUMBER:
496803537
ADMINISTRATOR/
DIRECTOR:		VEGVARY, JULIUSFACILITY TYPE:
740
ADDRESS:340 GREENE STREETTELEPHONE:
(707) 483-0998
CITY:KENWOODSTATE: CAZIP CODE:
95452
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
03/27/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:04 AM
MET WITH:Julius Vegvary, AdminstratorTIME VISIT/
INSPECTION COMPLETED:
03:47 PM
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Licensing Program Analyst (LPAs) Christi Coppo and Ethel Contreras arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Julius Vegvary and Mercedes Vegvary.

At approximately 9:30am LPAs and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPAs observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. Laundry room located off kitchen was locked and all cleaning supplies were locked in cabinets.

All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean. Room #3 has flooring that is worn and lifting up such that it could present as a tripping hazard. Admin agrees to immediately replace and send pictures of replacement to CCL no later than April 17, 2025. Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bar. Water temperature in sinks accessible to residents in care did not measure within regulation upon first measurements. Admin immediately adjusted water heater temperature and LPAs tested the water again after a period of time. Water then measured at 112.2 degrees F in the cottage, which is within the allowable range of 105 to 120 degrees F. Admin and licensee agree to keep an eye on the water temperature.

Fire extinguishers were last inspected 2/27/25. Smoke/Carbon Monoxide detectors located throughout the facility and cottage are hardwired, along with sprinklers, and are serviced by a vendor. Detectors are serviced annually and were last serviced March 2025. Facility’s last quarterly disaster drills were conducted 12/31/24. LPA reminded Admin to conduct drills quarterly. Facility has a backup generator for use during a power outage.

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Victoria BertozziTELEPHONE: (707) 588-5059
Christi CoppoTELEPHONE: (707) 588-5054
DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2025
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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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: KENWOOD GREENS
FACILITY NUMBER: 496803537
VISIT DATE: 03/27/2025
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At approximately 11:00am LPA conducted review of five [5] staff records. CPR card present for S1 but not First Aid, card stated AED/CPR for Infant and Child but no First Aid completed. Admin was unaware that training did not include First Aid. All other staff have First Aid completed. Admin will have S1 complete First Aid by no later than 4/2/25.



LPA reviewed staff training documentation and materials. Admin is using CCL PINs and printed handouts from Advanced Healthcare Studies, no publication date present, but appears to be outdated. LPA reviewed documentation of training which appeared to be fabricated: all training dates for staff conducted on the same day for all 5 staff members, some hours listed showed as many as 8 hours of training conducted on the same day. LPA asked Admin if all five staff are receiving training and she is the one conducting the training. who is attending to the residents. LPA also observed training documentation to be photocopied, no variation in dates or duration of time. Admin confirmed that training documentation was photocopied, but stated that it was not fabricated. LPA discussed with Admin the option of using an approved vendor to conduct training and print out the certificates issued as documentation, this could potentially mitigate the appearance of any fabrication. LPA also discussed with Admin the other option of purchasing training materials that are current, Admin will then submit the current training materials to CCL for approval. At the time of submission, Admin agrees to also present to LPA an example of how they will document the training. LPA and Admin will discuss together if the process by which the training will be documented is within regulation. Admin will submit training materials for approval no later than April 25, 2025.

At approximately 1:00pm LPA conducted a review of six [6] resident records. All required documentation present. 1/2 rails present and on file for all residents for which they are required.

At approximately 2:30pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked closet. No deficiencies

Julius Vegvary Administrator Certificate 7007660740 expired 11/14/2024.




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SUPERVISOR'S NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi CoppoTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: KENWOOD GREENS
FACILITY NUMBER: 496803537
VISIT DATE: 03/27/2025
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Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:

LIC500- Personnel Report
LIC308- Designation of Responsibility
Liability Insurance

Exit interview conducted with Administrator and a copy of this report was given.

No deficiencies cited

SUPERVISOR'S NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi CoppoTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC809 (FAS) - (06/04)
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