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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803820
Report Date: 11/03/2023
Date Signed: 11/03/2023 11:51:54 AM

Document Has Been Signed on 11/03/2023 11:51 AM - 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:ENSO VILLAGE, A KENDAL AFFILIATEFACILITY NUMBER:
496803820
ADMINISTRATOR:JORDAN, ROSEMARYFACILITY TYPE:
741
ADDRESS:1801 BOXHEART DRIVETELEPHONE:
(925) 366-3414
CITY:HEALDSBURGSTATE: CAZIP CODE:
95448
CAPACITY: 82CENSUS: 0DATE:
11/03/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rosemary Jordan, AdministratorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst Bertozzi arrived announced to conduct a Prelicensing inspection and met with Administrator, Rosemary Jordan and Welcome Guide, Kelly Hall.

LPA initiated a tour of the facility around 9:15 AM and made the following observations: Facility has four floors but only the first floor is being toured at this time due to facility opening in phases. LPA will return for each phase. Assisted Living and Memory Care areas are planned to be completed during the third phase. Currently, only independent residents have defined move-in dates. Facility has a large commercial kitchen with multiple food storage areas, a smaller bistro style kitchen, private dining room, offices for staff, common spaces, a balance room, and outdoor activity spaces. Required posting were observed. Administrator has reached out to the Local Long Term Care Ombudsman Office to obtain an Ombudsman Poster.

A fire clearance has been approved for 82 residents, 78 ambulatory and 4 non-ambulatory. Facility was a comfortable temperature and passageways were free from obstructions. Water temperature in a sample of residences measured at 118, 119 and 121.0 degrees F which are not all within allowable range of 105 to 120 degrees F. Showers in resident bathrooms are textured for safety and grab bars are available. Cleaning supplies are stored in locked storage rooms and once received, locked housekeeping carts will be used. Refrigerators and freezers read at required temperature. Facility has contracted with a company to deliver food multiple times per week and will increase food delivery as facility population increases. Facility has evacuation chairs at each stairwell. Each residence has a call button to alert staff if assistance is needed.

Continued on LIC 809C
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2023
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 2
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: ENSO VILLAGE, A KENDAL AFFILIATE
FACILITY NUMBER: 496803820
VISIT DATE: 11/03/2023
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Continued from LIC809

Fire extinguisher was last inspected September, 2023. Facility has a combination Smoke and Carbon Monoxide system that is maintained by a vendor and inspected by the local fire department.

Component III will be conducted when the Prelicensing of facility's third phase is completed.

Facility has reduced the temperature on the water system and will continue to test water to ensure it is within regulation. LPA has requested that the exit from the Balance Room remains off limits until the patio is complete and exiting is safe. Facility is currently working on landscaping throughout the property that is planned to be completed prior to residents moving in. LPA and Administrator discussed areas of potential risk including but not limited to construction areas, a cardboard compactor and a car barn. Construction areas have been made inaccessible by having temporary walls erected and placing individuals to redirect residents away from potentially dangerous areas. LPA observed that construction materials and tools were inaccessible.

LPA will notify the Centralized Application Unit to move forward with the application process.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
LIC809 (FAS) - (06/04)
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