496803915-8-3-2020-21-AS-DALO-BS64NR-20200803191535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 496803915
Report Date: 08/03/2020
Date Signed: 08/03/2020 07:16:51 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:	MARIE'S CARE HOME		FACILITY NUMBER:	496803915
ADMINISTRATOR:	BISCOCHO, LIZA		FACILITY TYPE:	740
ADDRESS:	7334 CARIOCA CT.		TELEPHONE:	(707) 794-0591
CITY:	ROHNERT PARK	STATE: CA	ZIP CODE:	94928
CAPACITY:	6	CENSUS: 4	DATE:	08/03/2020
TYPE OF VISIT:	Post Licensing	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Liza Biscocho-Administrator		TIME COMPLETED:	04:20 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) Alviso, conducted a post licensing tele-video inspection, on 8/3/2020 at approximately 3:00PM, and spoke with Administrator Liza Biscocho during the inspection. LPA also followed-up regarding Covid 19 Pandemic policies in place. LPA conducted the inspection by video conference call; The reader is advised that the LPA did not physically make a site visit. This inspection is being conducted by tele-video inspection due to COVID-19 precautions. LPA spoke with caregiver Marie Jamero, and conducted the tour with the caregiver. LPA had conducted a prelicensing inspection on 7/16/20, and also reviewed all Covid 19 pandemic precautions in place at the facility with the Administrator. There were no observed health and safety concerns during that inspection. All toxins and medications were locked up and inaccessible to residents in care. Food supply, perishable and nonperishable were observed to be sufficient. Facility common areas were observed to be clean and orderly, including what appeared to be sufficient lighting throughout the facility. Facility had emergency supplies to meet requirement for the 72 hour shelter in place. Postings noted to be current and in compliance with regulations. LPA discussed covid 19 precautions in place, and provider pins put out by the Department. Administrator aware of the provider pins. Licensee/Administrator continues to have sufficient supply of Personal Protective Equipment (PPE) for use as needed. Continued on LIC809C..

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: MARIE'S CARE HOME	FACILITY NUMBER: 496803915
	VISIT DATE: 08/03/2020

NARRATIVE

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Station set up at front door area with sanitizer gel, and where a staff person on duty will ensure staff, and essential visitors are screened, temperature taken, and questions asked of each essential visitor/staff as part of Covid 19 precautions in place. All postings required were posted, and visible upon arriving to the front entrance door outside of the facility. Postings were posted throughout the facility.

Administrator stated that she is operating the facility within regulations and with covid 19 pandemic policies in place.

LPA did not review resident files as current shelter in place only allows for essential medical visits at this time. In review with the Administrator regarding resident records, per Administrator all residents have up to date documents as needed and/or as required per regulation.

LPA reviewed with Administrator three (3) staff, All staff have criminal record clearance. All staff have current First Aid Certification and CPR Certification.
LPA discussed with the Administrator the regulations regarding resident records, and staff records that need to be on file, and ensuring these records are maintained per regulations. Administrator stated their understanding to the LPA of the discussion of regulations and requirements.

Licensee stated disaster drills are conducted quarterly. The facility fire alarm system, carbon monoxide detector(s), and fire extinguishers, were inspected for a fire clearance approval by the local Rohnert Park Fire Department-effective date of approval 7/2/2020. Per Licensee/Administrator all smoke alarms, fire extinguishers, and carbon monoxide detectors are working appropriately. Per Licensee all auditory exit door alarms are working properly. Fire extinguishers are tagged and cleared as required-exp 2021.
LPA has Licensee's current email address contact for the facility as needed for emergency information/contact that may be sent out to the Licensee.

No deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020

LIC809 (FAS) - (06/04)

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