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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600230
Report Date: 03/04/2025
Date Signed: 03/04/2025 12:54:06 PM

Document Has Been Signed on 03/04/2025 12:54 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MARINER'S GREEN RESIDENTIAL CAREFACILITY NUMBER:
415600230
ADMINISTRATOR/
DIRECTOR:
GUEVARRA, ANALIZA B.FACILITY TYPE:
740
ADDRESS:380 ENSIGN LANETELEPHONE:
(650) 591-6115
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94065
CAPACITY: 6CENSUS: 6DATE:
03/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Caregiver, Mely Garland TIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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On March 4, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual visit. LPA met with Caregiver, Mely Garland and explained the purpose of the visit.

LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageway was free of obstruction. No accessible bodies of water of fire safety hazards observed. This is a single story facility. There are six resident bedrooms, all of which were observed to be private rooms equipped with all required furnishings. LPA observed two full bathrooms and four half bathrooms. Bathrooms were clean, odor-free; equipped with paper towels, liquid soap and non-skid mats.

Living room and dining room was free from tripping hazards. A comfortable temperature was maintained and lighting was sufficient for comfort. LPA toured the kitchen and observed two day perishable and seven day non-perishables. Chemicals, medications and sharps were locked and inaccessible to residents in care.

Water temperature throughout the facility measured between 109-110 degrees F. LPA toured the garage and observed washer and dryer in good working condition. Extra linen was observed to be present. First aid kit was observed to be complete.

Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of January 2025. Emergency drills are logged and done every month. LPA reviewed 5 resident records and 5 staff records. Client records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated.

No citations are issued during this visit. Report is reviewed with caregiver and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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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