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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803905
Report Date: 06/30/2021
Date Signed: 06/30/2021 04:00:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ARBOL RESIDENCES OF SANTA ROSAFACILITY NUMBER:
496803905
ADMINISTRATOR:SORIANO, MARIELEFACILITY TYPE:
741
ADDRESS:300 FOUNTAINGROVE PARKWAYTELEPHONE:
(707) 566-8600
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:158CENSUS: 77DATE:
06/30/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Rogina McBurny-Health & Wellness DirectorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Dina Alviso conducted a case management health and safety inspection, and met with Health Services Director Rogina McBurny. The Administrator Mariele Soriano was not available to meet with the LPA.

This case management inspection is to conduct a health and safety check on the emergency placement residents that were admitted into the facility 6/14/21, and to obtain updated information as needed. LPA spoke with H&W Director Rogina McBurny and was able to obtain updated information.

LPA observed the residents in care at the facility. LPA observed Redwood staff on duty with the residents. Facility was at a comfortable temperature; LPA observed most of the residents were in the activity room, and a couple of the residents were napping. LPA spoke with Redwood lead staff regarding the residents, and staffing.

There were no deficiencies cited today.





SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina AlvisoTELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
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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