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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803687
Report Date: 03/14/2025
Date Signed: 03/14/2025 12:00:30 PM

Document Has Been Signed on 03/14/2025 12:00 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:ERIKA'S HOMEFACILITY NUMBER:
496803687
ADMINISTRATOR/
DIRECTOR:		ELIZABETH WISEFACILITY TYPE:
735
ADDRESS:2307 WARWICK DRIVETELEPHONE:
(707) 843-7310
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY: 4CENSUS: 3DATE:
03/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:09 AM
MET WITH:Elizabeth Wise, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs) Christi Coppo and Ethel Contreras arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Elizabeth Wise.

At approximately 9:30am LPAs 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. Some open food items were found not labeled. Head of cauliflower found with many
black spots and fuzzy brown spots observed. Admin immediately threw away head of cauliflower. Kitchen cabinet containing cleaning supplies was locked.

All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 107.4 degrees F which is within the allowable range of 105 to 120 degrees F.

Fire extinguishers were last inspected 5/23/24. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill 2/5/25. Facility has a backup generator for use during a power outage.

At approximately 10:00am LPAs conducted review of five [5] staff records. Two staff Health Screenings did not have staff name at the top, but did have address listed,so LPAs were able to identify staff to whom the health screenings belonged. Staff (S1) did have Concentra TB documentation present indicating they received a TB test, however, TB results not listed. S1 contacted Concentra in LPAs presence but was not able to get TB results delivered. S1 immediately made appointment to get TB re-done in presence of LPAs. S1 will send proof of TB clearance by no later than 3/19/2025.

Continued on 809C...
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: ERIKA'S HOME
FACILITY NUMBER: 496803687
VISIT DATE: 03/14/2025
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Continued from 809...

At approximately 10:30am LPAs conducted a review of three [3] resident records. All required documentation present.



At approximately 11:00am LPAs and Admin reviewed cash resources. P&I monies present and reconciled. Receipts present. No deficiencies.

At approximately 11:30pm LPAs and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies

Elizabeth Wise Administrator Certificate 6061070735 expires 4/08/2025.


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

No deficiencies cited.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025
LIC809 (FAS) - (06/04)
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