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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803591
Report Date: 11/04/2022
Date Signed: 11/04/2022 02:26:42 PM


Document Has Been Signed on 11/04/2022 02:26 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
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: 0DATE:
11/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Nagra K. SarjeetTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Walters arrived at the home for the purpose of conducting a closure inspection pursuant to voluntary closure of this licensed Residential Care Facility for the Elderly. LPA arrived and was allowed in by Administrator/Licensee Nagra Sarjeet.

LPA inspected the rooms and the exterior of the building today and found no evidence that would suggest that any resident/client are residing on the premises. All clothing and personal items belonging to clients have also been removed. There are now 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. Per Licensee, all residents were removed from the facility by veterans home in 2021 to other care homes.

The Licensee initiated this facility closure with plans for retirement. On 10/12/2022 LPA Walters was notified by Licensee/Administrator, Nagra Sarjeet about their plan to close the facility. Closure of this facility has been finalized. Facility closure is effective 11/05/22. Licensee was unable to access to the facility license during the visit. Nargra S. agreed to mail a copy of the original license to community care licensing Santa Rosa.

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: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022
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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