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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803905
Report Date: 03/27/2024
Date Signed: 03/27/2024 02:17:42 PM


Document Has Been Signed on 03/27/2024 02:17 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:ARBOL RESIDENCES OF SANTA ROSAFACILITY NUMBER:
496803905
ADMINISTRATOR:TA, HANHFACILITY TYPE:
741
ADDRESS:300 FOUNTAINGROVE PARKWAYTELEPHONE:
(707) 566-8600
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:152CENSUS: 93DATE:
03/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Karina Tapia-Health & Wellness DirectorTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA), Alviso, conducted a case management visit, on 3/27/24 at approximately 9:10am, and met with Karina Tapia, Health & Wellness Director.

LPA reviewed a resident incident reported to the Department, and obtained more information. LPA obtained copies regarding the incident. LPA toured the memory care unit. The LPA conducted interviews, with staff, and other parties.

The LPA reviewed with H&W Karina Tapia, to ensure the required postings/signage be placed in the main entry area of the facility, so they are easily noticed and seen by all who enter the facility, as required. H&W Director stated there understanding of the postings/signage requirements. Executive Director Marcus Strohschei was also there during the discussion regarding the postings/signage be in a conspicuous place. The LPA will be back to the facility to follow-up with the above.

No deficiencies cited during today's visit.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina AlvisoTELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
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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