496803886-3-10-2026-21-AS-CCOO-DS2VV9-20260310164559

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 496803886
Report Date: 03/10/2026
Date Signed: 03/10/2026 04:47:19 PM

Document Has Been Signed on 03/10/2026 04:47 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	H & M'S THE ROSE GARDEN		FACILITY NUMBER:	496803886
ADMINISTRATOR/ DIRECTOR:	GARCIA, MAGGIE		FACILITY TYPE:	740
ADDRESS:	2370 MELBROOK WAY		TELEPHONE:	(707) 546-2429
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95405
CAPACITY: 6		CENSUS: 6	DATE:	03/10/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:55 PM
MET WITH:	Maggie Garcia, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

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) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Licensee Heherson Garcia arrived later, followed by Maggie Garcia. Facility currently has six (6) residents in care one of which is currently on hospice. Administrator certificate # for Heherson Garcia 7020012740 exp 12/2/27 and certificate # 7008481740 exp 5/5/27 At approximately 1:30pm LPA and licensee toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed a 2 day supply of perishable and at least a 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled with opened dates present. LPA observed kitchen cabinet under sink to be locked. All other cleaning products and laundry soaps are located in the garage and inaccessible to residents in care. Sharp knives cabinet has magnetic locking function. Facility has video cameras in the common areas, at the front door, and on the sides of the facility. Video Camera Policy Admission Agreement Addendum present. LPA observed Addendum to be signed by all residents or their responsible party. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 113.4 degrees F in the front bathroom and 110.9 in the back bathroom and 114.2 degrees F in the kitchen, all of which are within the allowable range of 105 to 120 degrees F. Continued on 809C...

NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/10/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: H & M'S THE ROSE GARDEN	FACILITY NUMBER: 496803886
	VISIT DATE: 03/10/2026

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Continued from 809...

Fire extinguishers were last inspected 1/6/26. Fire alarm hardwired and serviced annually, last serviced January 2026. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted on 3/9/26. Facility has a backup generator for use during a power outage.

At approximately 2:00pm LPA conducted a review of five [5] staff records. All documentation present. Training hours and subjects of training in compliance. LPA discussed Health and Safety Code (HSC) 1569.69 with licensee and discussed all staff that administer medications, including PRNs, must have the training outlined in HSC1569.69.

At approximately 2:30pm LPA conducted a review of six [6] out of six [6] resident records. All documentation present, except for TB clearance for resident (R1). However, LPA was able to verify with day program director that TB clearance for R1 was on file with them. LPA discussed importance of having all required documentation present at time of move-in for all residents, especially that showing clearance of communicable disease.

At approximately 3:30pm LPA and licensees conducted a medication review. LPA went over requirement for PRN MAR and need for all PRNs to be listed on the Centrally Stored Medication Log (CSML).

LPA and licensee discussed Infection Control Plan. LPA and licensee discussed Emergency Disaster Plan. Licensee confirmed no updates needed but were reviewed.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:
LIC500- Personnel Report
LIC308- Designation of Responsibility

No deficiencies cited. Exit interview conducted with licensees and a copy of this report given.

NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/10/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026

LIC809 (FAS) - (06/04)

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