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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803760
Report Date: 02/18/2025
Date Signed: 02/18/2025 04:37:15 PM

Document Has Been Signed on 02/18/2025 04:37 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:SUNSET GARDEN IIFACILITY NUMBER:
496803760
ADMINISTRATOR/
DIRECTOR:
RELOTA, EDENFACILITY TYPE:
740
ADDRESS:320 KIVA PLACETELEPHONE:
(707) 548-5753
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
02/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:55 PM
MET WITH:Eden Relota-AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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Licensing Program Analysts (LPAs) Alviso and Contreras arrived unannounced to conduct a Required -1 Year inspection, on 2/18/25 at approximately 2:55pm, and met with caregivers Dina Camilon and Estelita Cabardo. Staff contacted Administrator Eden Relota, and notified them the LPAs were at the facility. The Administrator arrived to meet with the LPAs.

Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. The facility has a required infection control plan. The facility has a required emergency and disaster plan. Per file review, last fire drill was completed on 12/5/23. Licensee is completing fire/evacuation/emergency drills quarterly as required.

Fire clearance is approved for four (4) non-ambulatory, of which one(1) may be bedridden. There were four (4) residents in care at the facility. Two (2) fire extinguishers were serviced and tagged as required. All exits were clear and free of obstructions. All exits had auditory alarms on the doors; All alarms were working properly during the inspection. Facility has a carbon monoxide detector that was working properly during the inspection.

LPA reviewed four (4) resident files, including medication storage and medication records.

LPAs toured the facility. Hot water was checked at 107. degrees Fahrenheit. All smoke alarms were in place and working properly. Sufficient food supply. All medications were locked up and inaccessible to residents in care. All disinfectants/cleaners were locked up and inaccessible to residents in care.

LPAs will return at a later date to continue the annual inspection.
Bethany MoellersTELEPHONE: (707) 588-5040
Dina AlvisoTELEPHONE: (707) 588-5082
DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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