576804189-10-2-2025-21-AS-JNAA-DM3USV-20251002155057

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 576804189
Report Date: 10/02/2025
Date Signed: 10/02/2025 03:51:12 PM

Document Has Been Signed on 10/02/2025 03:51 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	ALAGA RANCH		FACILITY NUMBER:	576804189
ADMINISTRATOR/ DIRECTOR:	ABDALLA,DOUGLAS		FACILITY TYPE:	740
ADDRESS:	34606 CA-16		TELEPHONE:	(530) 668-8444
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95695
CAPACITY: 23		CENSUS: 12	DATE:	10/02/2025
TYPE OF VISIT:	Post Licensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:20 PM
MET WITH:	Maggie Perri, Facility Director on site		TIME VISIT/ INSPECTION COMPLETED:	03:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/02/2025 Licensing Program Analyst (LPA) Jill Nakagawa conducted a post-licensing inspection and was greeted by Facility Director Maggie Perri. Fire Clearance has been approved for 23 non-ambulatory, 10 of which may be bedridden. There were 12 residents and 4 staff at the time of inspection. LPA conducted a tour of the facility grounds and found them to be clear of debris. The property houses goats and chickens, fruit trees and many safe pathways for residents to enjoy the outdoors. The interior of the facility was clean and odor-free. Residents were enjoying games and socialization during the visit. The facility is homey and decorated for Fall. Fire extinguishers throughout the facility were found to be last charged on 11/14/2024. Smoke detectors and carbon monoxide detectors were found to be in working order. Last fire drill was held on 06/18/2025. Water temperature was measured throughout the facility and found within regulation between 105 & 120 degrees F. An additional supply of hygiene, continence and paper products are located in a secured storage closet. Hallways are illuminated around the clock for accessibility and resident safety. Bedrooms had required furnishings and linens. Kitchen was clean and sanitary and well-stocked with perishable and non-perishables, as required per regulation and sufficient for the 12 residents in care. There is a sufficient amount of dishes and cooking supplies with sharps and other hazardous items kept secured in designated drawer. A sample menu is posted in the kitchen located on the refrigerator and indicates a healthy and balanced set of meals for residents in care. Cleaning products and other toxins and chemicals are kept out of client access and found secured in the office and laundry room cabinets. Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Kimberley Mota
NAME OF LICENSING PROGRAM ANALYST: Jill Nakagawa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: ALAGA RANCH	FACILITY NUMBER: 576804189
	VISIT DATE: 10/02/2025

NARRATIVE

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Continued from 809....

Medications are centrally stored and secured in locked medication carts in both buildings with Centrally Stored Medication Records and several other medication related forms on file. Client specified files including care plans, medical reports and dietary restrictions are secured in an office located off the main building with all appropriate staffing records, program operation documentation and emergency disaster information

The second building is called La Casita and has four residents. There is a kitchen, living room and dining room with a large deck for residents to enjoy. All required furnishings and additional amenities were in place. Residents from both houses socialize together from time to time. La Casita has a large deck with seating to observe the pasture nearby, which has horses and goats.
The facility has an up-to-date Activity Calendar with activities planned throughout the day.

No deficiencies found at the time of inspection. No citations issued.

This report was reviewed with Facility Director and a copy was provided to the Licensee.

NAME OF LICENSING PROGRAM MANAGER: Kimberley Mota
NAME OF LICENSING PROGRAM ANALYST: Jill Nakagawa
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC809 (FAS) - (06/04)

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