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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803896
Report Date: 03/14/2025
Date Signed: 03/14/2025 03:15:12 PM

Document Has Been Signed on 03/14/2025 03:15 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:MARIAN GARDENS CARE HOME - RCFEFACILITY NUMBER:
496803896
ADMINISTRATOR/
DIRECTOR:		DICHOSO, RAYMOND C.FACILITY TYPE:
740
ADDRESS:4908 STONEHEDGE DRTELEPHONE:
(707) 791-3141
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY: 6CENSUS: 6DATE:
03/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Raymoind Dichoso, AdminstratorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPAs) Christi Coppo and Ethel Contreras arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Raymond Dichoso.

At approximately 1:00pm LPAs and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPAs observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked.

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 bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 106.2 degrees F which is within the allowable range of 105 to 120 degrees F.

Fire extinguishers were last inspected 4/22/24. Smoke/Carbon Monoxide detectors located throughout the facility were operational. Facility’s last quarterly disaster drills were conducted 1/13/25 and 1/25/25. Facility has a backup generator for use during a power outage.

At approximately 1:20pm LPAs conducted a review of six [6] resident records. All required documentation present. 1/2 rails and crushed meds orders all on file for respective residents.

At approximately 2:00pm LPAs conducted review of five [5] staff records. All required documentation present. LPAs and Admin discussed training and training materials. Some staff were slightly short on completed training hours required. Per Admin, Admin conducts training periodically throughout the year but

Continued on 809C...
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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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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: MARIAN GARDENS CARE HOME - RCFE
FACILITY NUMBER: 496803896
VISIT DATE: 03/14/2025
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mainly conducts annual training in January. LPA explained that in order for training to be considered current it must be completed within the current year, so any training conducted after 3/14/24 would be considered current. Admin now understands the dates by which the training must be completed in order to be considered current. LPA reviewed training materials. LPA and Admin discussed using an approved vendor to complete training for staff as current materials are over 10 years old. LPA will email approved vendor list to Admin, If Admin does not choose to go with an approved vendor, Admin will update training materials and submit to CCL for approva once purchased.

At approximately 2:30pm LPAs and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies.

Raymond Dichoso Administrator Certificate 7005427740 expires 8/31/26. All fees are current as of this time.




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
Liability Insurance

Exit interview conducted with Administrator and a copy of this report was given.

No deficiencies cited.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025
LIC809 (FAS) - (06/04)
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