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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803933
Report Date: 07/19/2023
Date Signed: 07/19/2023 10:09:16 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2023 and conducted by Evaluator Shannan Hansen
COMPLAINT CONTROL NUMBER: 21-AS-20230131081425
FACILITY NAME:ST. MICHAEL ASSISTED LIVINGFACILITY NUMBER:
496803933
ADMINISTRATOR:CARDENAS, CRISANTE MFACILITY TYPE:
740
ADDRESS:804 ST. FRANCIS STTELEPHONE:
(707) 763-8289
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY:6CENSUS: 0DATE:
07/19/2023
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Marilyn Green, LicenseeTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Facility is in financial distress
INVESTIGATION FINDINGS:
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Findings to allegation of facility is in financial distress was delivered today in the Santa Rosa Regional office to Licensee Marilyn Green along with department forfeiture letter.

Regarding the allegations of facility is in financial distress, the department conducted a thorough investigation and the Solvency Audit Report concluded that operating income is generated on a consistent basis at the facility, Licensee maintains sufficient reserves to ensure provision of care and supervision to residents, and Licensee complied with applicable laws and regulations during the audit period. Therefore, the licensee has established and maintains a financial plan that complies with financial requirements for RCFE’s as contained in CCRC, Title 22, Divison 6, Chapter 8, Section 87213 Finances: The allegation is Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
Continue on LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 21-AS-20230131081425
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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. MICHAEL ASSISTED LIVING
FACILITY NUMBER: 496803933
VISIT DATE: 07/19/2023
NARRATIVE
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The department conducted a final walk through of the facility on 6/16/2023 finding there were no residents in care. The licensee turned over the license on 6/16/2023 the license is no longer valid. Today the department provided a copy of the forfeiture letter for the licensee-initiated closure completing the closure process.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2