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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803924
Report Date: 12/19/2024
Date Signed: 12/19/2024 11:56:05 AM

Document Has Been Signed on 12/19/2024 11:56 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SONOMA GROVEFACILITY NUMBER:
496803924
ADMINISTRATOR/
DIRECTOR:
ALEXANDER VARSHAVSKYFACILITY TYPE:
740
ADDRESS:765 DONALD STREETTELEPHONE:
(415) 264-5486
CITY:SONOMASTATE: CAZIP CODE:
95476
CAPACITY: 32CENSUS: DATE:
12/19/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:17 AM
MET WITH:Alex Varshavsky, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a plan of correction visit and was greeted by Administrator Alex Varshavsky.


On 9/16/24 LPA conducted required annual inspection and found the following water temperature measurements in sinks accessible to residents: room #7 measured at 99 degrees F, room #8 measured at 84 degrees F, room #11 at 96 degrees F, room #12 measured at 97 degrees F, and room #16 measured at 87 degrees F, all of which were outside of the allowable range of 105 to 120 degrees F. Deficiency citation was issued.

Today, 12/19/24, at approximately 11:25am, LPA and Admin went together to measure the water temperature in rooms #7, #8, #11, #12, and #16, respectively. The following water measurements were observed in degrees F:

  • 105.2 in room #7
  • 105.0 in room #8
  • 105.2 in room #11
  • 106.2 in room #12
  • 105.3 in room #16

All water temperature measurements were within the allowable range of 105 to 120 degrees F. The plan of correction for deficiency of regulation 87303(e)(2) is therefore now considered satisfied.

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

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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