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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804028
Report Date: 04/09/2024
Date Signed: 04/09/2024 03:26:43 PM


Document Has Been Signed on 04/09/2024 03:26 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:TREEHOUSE SENIOR LIVINGFACILITY NUMBER:
496804028
ADMINISTRATOR:PATEL, DHARMISTHABENFACILITY TYPE:
740
ADDRESS:1879 ALAN DRIVETELEPHONE:
(707) 665-5624
CITY:PENNGROVESTATE: CAZIP CODE:
94951
CAPACITY:10CENSUS: 7DATE:
04/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Administrator, Dharmi PatelTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 1:20PM to conduct an Annual Required inspection. LPA was greeted by staff, and discussed the purpose of the visit. Administrator, Dharmi Patel arrived shortly after.

LPA and Administrator initiated a tour of the facility around 1:45 PM and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in sinks accessible to clients measured at 116 and 115 degrees F which is within the range of 105 to 120 degrees F allowed per regulation.

Extra hygiene products and linens were available. Cleaning supplies are stored in the garage in a locked cabinet. Facility has at least two days of perishable and one week of non-perishable foods which were of quality and stored per regulation. Medications were centrally stored and locked. Emergency food and water is stored in the kitchen. Personal Protective Equipment is stored in the garage.

Fire extinguishers were last serviced March 2024. Facility smoke and carbon monoxide detectors located throughout the facility were tested and operational during inspection.

LPA is unable to complete inspection at this time and will return to complete inspection at a later date.

No deficiencies cited during inspection.
SUPERVISOR'S NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Helena RummondsTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
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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