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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803929
Report Date: 03/22/2021
Date Signed: 03/23/2021 08:18:59 AM

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:MAGGIE'S CARE HOMEFACILITY NUMBER:
496803929
ADMINISTRATOR:GARCIA, MAGGIEFACILITY TYPE:
740
ADDRESS:916 RENEE COURTTELEPHONE:
(707) 568-7497
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:6CENSUS: 5DATE:
03/22/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
12:33 PM
MET WITH:Maggie Garcia (Licensee)TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Cuadra conducted the Post Licensing inspection via video conferencing due to Covid19 precautions with Licensees, Maggie & Heherson Garcia. There are currently 5 residents in care.

LPA/Licensee conducted a walk through via video conferencing, Facility has space indoors and outdoors for resident activities. During the tele-visit LPA/Licensee observed that visitors wearing face masks came to the facility and were screened by staff. All facility bedrooms have all personal accommodations. Each bed has a mattress pad. All bedrooms have adequate lighting, closet and dresser space. Two bathrooms were equipped with non-slip floors and mats for safety. Water temperature tested at 105.9 and 106.8 degrees F within regulation. Facility received an approved fire clearance 09/17/20 that allows all bedrooms for non-ambulatory residents. Facility has at least two days of perishable and one week of non-perishable food available for residents in care. Food supplies are maintained in the kitchen as well as a surplus of food in the garage. There is a deep freezer and upright refrigerator in the garage. Cabinet containing cleaning supplies and kitchen drawer containing other items that could pose a risk were locked. Fire extinguisher was last inspected March 1, 2021. First aid kit was fully stocked. Facility has hardwired combination smoke/ carbon monoxide detectors that were tested and operational. Exit doors have auditory alerts that were functional at time of visit.



LPA observed required postings (LTCO, CCL Complaint poster, visitor policy, employee and personal rights). in addition to COVID-19 required visitation postings. Facility has a sanitation station set up at the entrance to the facility in order to comply with Covid-19 precautions. The facility staff was observed wearing mask during the virtual tour of main entrance, doors, common areas, dining rooms and kitchen area. Facility provides assistance with family communication via telephone or video call. Administrator certificate – Maggie Garcia #6027894740 expires 5/5/2021. Per Licensee, resident and staff records are maintained. Medication is centrally stored and locked in a closet. A Centrally Stored Medication Log is maintained.

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
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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