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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803915
Report Date: 06/06/2023
Date Signed: 06/06/2023 05:32:30 PM


Document Has Been Signed on 06/06/2023 05:32 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:MARIE'S CARE HOMEFACILITY NUMBER:
496803915
ADMINISTRATOR:BISCOCHO, LIZAFACILITY TYPE:
740
ADDRESS:7334 CARIOCA CT.TELEPHONE:
(707) 794-0591
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:6CENSUS: 4DATE:
06/06/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Liza Biscocho, AdministratorTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Alviso conducted a continuation of the Required 1-Year visit, on 6/6/23 at approximately 2:30pm, and met with caregivers, Christal Datayan and Michelle Angeles. The Required 1-Year visit was started on 6/1/2023, see report LIC809 of this date.

The caregiver, Christal, contacted the Administrator Liza Biscocho to notify her of the LPA's arrival to the facility; The Administrator arrived to meet with the LPA shortly after being contacted by staff.

LPA toured the facility with the Administrator. The food supply was sufficient with perishable and non-perishable food. Facility had a supply of emergency food and water to meet the 72 hour shelter in place requirement. Facility also had emergency supplies such as flashlights, batteries, and other items for use as needed in an emergency. Per file review, the facility conducted an evacuation drill on 2/18/23, and a fire drill on 5/12/23.

LPA observed four(4) residents in care at the facility during this inspection. Two(2) residents are on hospice care. Facility has an approved hospice waiver for three (3) residents. Facility has an approved dementia plan of operation. Facility has an emergency disaster and evacuation plan as required. Facility has an infection control plan as required. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden.

LPA reviewed four(4) staff files. All staff required to have first Aid and CPR had current certification. The Administrator is a licensed RN, copy of current license in the file. LPA reviewed staff training. All files were complete. LPA reviewed 4 resident files. All files were complete.

There are no deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina AlvisoTELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
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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