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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803591
Report Date: 09/23/2022
Date Signed: 09/23/2022 03:45:17 PM


Document Has Been Signed on 09/23/2022 03:45 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:MARINA CARE HOMEFACILITY NUMBER:
486803591
ADMINISTRATOR:SARJEET K. NAGRAFACILITY TYPE:
740
ADDRESS:1100 KELLOGG STREETTELEPHONE:
(707) 816-8765
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:3CENSUS: DATE:
09/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:12 PM
MET WITH:Nagra SarjeetTIME COMPLETED:
03:58 PM
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Licensing Program Analyst (LPA), Katrina Walters arrived at Marina Care Home facility for the purpose of conducting a Required 1-year inspection. LPA was greeted by Administrator/Licensee, Nagra Sarjeet (NS). There were no residents in care at the time of inspection.

Upon arrival LPA learned there are currently no residents in care. The home is not being used as a facility at this time. Because the facility is licensed they're subject to an inspection. LPA learned that there are 3 tenants residing in the home that do not require care and supervision. Additionally, there has been a change to the layout of the home.

licensee is unsure whether they will resume licensure of this facility, should they want to close the facility, the licensee will need to submit a forfeiture letter along with their original license. If the Licensee chooses to continue with their license, the licensee agrees to submit the following within 2 weeks:
  • Licensee will develop a plan send a plan to CCL
  • Update facility sketch to include any revisions
  • Provide fingerprint clearance for all tenants
  • Have fire extinguisher serviced and send copy to LPA.

Licensee agrees to not accept any residents in care without approval from community care licensing regional office. Once current plan is received. Licensee agrees to schedule and informal meeting with RO, to discuss plans moving forward.

LPA continued to conduct a walk-through of the interior and exterior portions of the facility with the Administrator. Administrator has personal protective equipment. Fire Extinguisher was found to be last charged June 2021 at the time of the visit. Facility smoke detectors were found to be functioning properly. There two technical advisories issued for
There were no deficiencies cited during today's visit.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2022
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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