<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803905
Report Date: 12/09/2021
Date Signed: 12/09/2021 01:44:18 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: DATE:
12/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mariele Soriano-AdministratorTIME COMPLETED:
01:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Dina Alviso arrived at Arbol Residences of Santa Rosa, on 12/9/2021 at approximately 1:00pm and met with Administrator Mariele Soriano. The case management inspection is being conducted regarding a request of a capacity change. LPA was screened in the front entrance lobby for COVID-19 prior to being allowed to stay in the facility.

A request to decrease the facility capacity, and also renovation plans were received from the Licensee. The capacity change requesting to go from 158 to 152 residents, which also included some renovation plans to the common area, and Bistro on 1st floor, and renovations to resident units on the 3rd floor. All renovations of the 3rd floor and the common area are complete, and facility did receive fire clearance approval. The capacity will decrease from 158 to 152 residents.
Xc.//
Fire clearance approval for 152 nonambulatory, which includes 25 bedridden-effective 12/8/21; Third floor approved for non-ambulatory only. LPA toured the renovated common area, and the 3rd floor. LPA did not observe any health and safety hazards during the inspection of the third floor. Administrator agrees to continue ensuring the health and safety of all residents in care in regards to the work that is still be done in the Bistro area.

Community Care Licensing has approved the change in capacity decrease-effective today 12/9/21. Administrator may move forward with repopulating the third floor with residents.

No deficiencies cited. Exit interview conducted with Administrator Mariele Soriano.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina AlvisoTELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1