<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804049
Report Date: 07/11/2022
Date Signed: 07/11/2022 10:10:50 AM


Document Has Been Signed on 07/11/2022 10:10 AM - 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:SONOMA GREENS II LLCFACILITY NUMBER:
496804049
ADMINISTRATOR:MARIMBI, MARTHAFACILITY TYPE:
740
ADDRESS:805 COUNTRY CLUB DR.TELEPHONE:
(707) 304-9106
CITY:SONOMASTATE: CAZIP CODE:
95476
CAPACITY:6CENSUS: 4DATE:
07/11/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Martha MarimbiTIME COMPLETED:
10:20 AM
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) Erik Gonzalez Campos arrived unannounced on 07/11/2022 at approximately 9:00 AM to conduct a Post Licensing inspection. LPA met with administrator/licensee Martha Marimbi. Upon arrival LPA was screened for COVID symptoms and required to sign in.

LPA toured facility with administrator. Building and grounds were clean and in good repair. All walkways were unobstructed. There are currently 4 residents in care. The amount of fresh and nonperishable foods was within regulation. Toxins are secured and inaccessible in locked laundry cabinet. Medications are locked and centrally located in hallway closet, first aid kit is located in the same closet. LPA recorded a water temperature of 108.1 degrees which is within regulation of of 105 and 120 degrees F at faucets accessible to residents. Bathrooms were equipped with necessary grab bars and non-slip floors/mats and had sufficient hygiene products. Fire extinguisher inspected was charged and dated 01/18/2022. Smoke detectors and carbon monoxide detector were operational. LPA observed required postings (LTCO, CCL Complaint poster) in addition to COVID-19 postings. Staff who are not boosted submit to weekly COVID testing.

LPA and administrator discussed best practices for medication record keeping. LPA provided administrator with regulation on incidental medical and dental care.

Facility to undergo infection control training on 07/13/2022.

LPA requested the following documents: LIC 9020, LIC 500

Exit interview conducted with administrator and a copy of the report printed for the facility.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1