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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801205
Report Date: 04/03/2024
Date Signed: 04/03/2024 04:25:20 PM


Document Has Been Signed on 04/03/2024 04:25 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:HOEN'S CARE HOMEFACILITY NUMBER:
496801205
ADMINISTRATOR:ALCONES, LILY O.FACILITY TYPE:
740
ADDRESS:1618 MARIPOSA DRIVETELEPHONE:
(707) 573-8922
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY:6CENSUS: 6DATE:
04/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Hazelyn Azucena, facility designeeTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced and was greeted by facility designee, Hazelyn Azucena. LPA arrived at facility to amend deficiency page issued during POC visit on 3/22/2024. LPA amended deficiency page to include plan of correction. Administrator Arthur Alcones was contacted via telephone to be advised of LPA visit and purpose of visit.

Exit interview conducted with facility designee, a copy of this report and the amended deficiency page was given.
SUPERVISOR'S NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi CoppoTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024
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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