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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803049
Report Date: 03/13/2025
Date Signed: 03/13/2025 05:24:14 PM

Document Has Been Signed on 03/13/2025 05:24 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:VARENNA AT FOUNTAINGROVEFACILITY NUMBER:
496803049
ADMINISTRATOR/
DIRECTOR:		BUOT, FERDINANDFACILITY TYPE:
741
ADDRESS:1401 FOUNTAINGROVE PKWYTELEPHONE:
(801) 815-0808
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 322TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
03/13/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Ferdinand Buot-AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Alviso conducted a case management inspection, on 3/13/25 at approximately 9:20am, and met with Executive Director/Administrator Ferdinand Buot, and Administrator Assistant Don Rodreick.

Case management is being conducted to obtain information on a resident incident reported by the facility. LPA reviewed resident (R1) records, including incident reports and admission agreement. LPA reviewed facility records, including facility's policy and procedures regarding theft & loss, safeguarding residents personal property. The LPA requested copies of records; Administrator provided copies to the LPA during the inspection. LPA interviewed staff, and other related parties regarding the incident.

There were no deficiencies cited during today's inspection.
Exit interview conducted with the Administrator Ferdinand Buot.
Bethany MoellersTELEPHONE: (707) 588-5040
Dina AlvisoTELEPHONE: (707) 588-5082
DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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