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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803820
Report Date: 11/17/2023
Date Signed: 11/17/2023 03:03:20 PM

Document Has Been Signed on 11/17/2023 03:03 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: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:
11/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Administrator, Rosemary JordonTIME COMPLETED:
03:15 PM
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Licensing Program Analyst Bertozzi arrived unannounced to conduct a Case Management inspection and met with Administrator, Rosemary Jordon.

Facility has requested a change of capacity to add additional apartments as part of their second phase. All apartments are designated for residents who are independent. The facility does not plan to add apartments for residents in assisted living and memory care until their third phase.

LPA initiated a tour of the areas identified in Phase 2 around 1:20pm and observed the following: Facility is completing final construction including but not limited to painting, wall touch ups, electrical outlet covers and some landscaping. Facility is also completing a sidewalk outside of a separate building that would house twenty independent residents. These final items are anticipated to be completed no later than 11/20/2023.

The facility has a Zendo that is part of Phase 2 but not yet completed. Area is locked to ensure resident safety until completed and anticipated completion date is 11/22/2023. The Balance Room is completed and facility would like to utilize the space prior to the patio area being completed. Individuals do not need to use the patio to gain access to the room so facility will create a physical barrier to make the patio inaccessible while still allowing for residents to use the space.

LPA will return once construction areas are complete.

No deficiencies cited.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
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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