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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803915
Report Date: 06/01/2023
Date Signed: 06/06/2023 02:48:59 PM


Document Has Been Signed on 06/06/2023 02:48 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:
06/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Liza Biscocho-Licensee/AdministratorTIME COMPLETED:
06:15 PM
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Licensing Program Analyst (LPA) Dina Alviso conducted a Required 1-Year visit, on 6/1/23 at approximately 4:20pm, and met with Licensee/ Administrator Liza Biscocho. LPA observed a caregiver on duty.

LPA observed four(4) residents in care at the facility during this inspection; Two 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 toured the facility with the Administrator. LPA observed a screening area, for use as needed, in the living room as you enter the facility. Hot water was checked at 110.F which is within regulation. All exits were free of obstructions. All smoke detectors, nine(9), were working properly when checked during the inspection. Two(2) of nine(9) smoke detectors were also carbon monoxide detectors, and both worked properly when checked during the inspection. Fire extinguishers(2 of 2) were serviced and tagged as required, expires 1/13/24. All resident rooms, hallways, bathrooms, and common areas all had sufficient lighting, including night lights. All bathrooms had grab bars for resident use as needed, and showers for bathing had non-skid flooring/mats for resident use as needed. Medications were locked and inaccessible to residents in care. All toxins and cleaners were locked up and inaccessible to residents in care. The facility was at a comfortable temperature, and the facility was clean and orderly. LPA observed a variety of fruit on the kitchen counter for residents. The food supply was sufficient for residents in care. The backyard has patio furniture for residents use; All walkways outside in the backyard were free from obstructions. The backyard was clean, and orderly for residents use.

No deficiencies cited today.
The Required 1-Year visit will be continued by the LPA at a later date.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina AlvisoTELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
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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