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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803929
Report Date: 06/03/2022
Date Signed: 06/03/2022 02:36:38 PM


Document Has Been Signed on 06/03/2022 02:36 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:MAGGIE'S CARE HOMEFACILITY NUMBER:
496803929
ADMINISTRATOR:GARCIA, MAGGIEFACILITY TYPE:
740
ADDRESS:916 RENEE COURTTELEPHONE:
(707) 293-9833
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:6CENSUS: 0DATE:
06/03/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Heherson and Maggie Garcia (Licensee)TIME COMPLETED:
02:30 PM
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An informal meeting was conducted today in the Santa Rosa Regional Office via Microsoft Teams due to Covid19 precautions. Present in the meeting were Licensing Program Manager Bethany Moellers, Licensing Program Analyst Marisol Cuadra and Licensees Heherson and Maggie Garcia.

The purpose of the informal conference was explained to the Licensees. The Licensees was informed that this informal virtual meeting is a part of the Administrative Action process and that further and/or repeat citations may result in a formal Non-Compliance Plan. The legal administrative action process was explained to Mr Garcia and Mrs. Garcia which is based on substantiated complaint findings found on complaint investigations.

Items addressed in today's meeting include but are not limited to patterns and trends in the areas below:
· Reporting Requirements of incidents occurred at the facility were not notified to CCL.
· Personnel Requirements including lack of required staff training and association of new hires.
· Elopement Procedures including updates to resident’s care plans including wandering behaviors.

Documents requested during informal meeting to be submitted to CCL by June 10, 2022:

· Licensee will submit an updated LIC500.
· Licensee will submit AWOL procedures to their Plan of Operation.

No deficiencies cited during today’s informal conference office visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2022
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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