Sonoma Greens II

Type of visit: POC

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a POC visit and was greeted by caregiver. Licensee present at facility and met with LPA. On 4/29/26 LPA conducted an annual inspection. Staff (S1, S3, and S4) all had start dates in 2026 and therefore were required to have 40 hours of training to be completed. At time of annual inspection, S1 had completed 26 hours, S3 had completed 21 hours, and S4 had completed 35 hours. S5's start date was in 2022 and had completed 12 hours of the required 20 hours. The deficiency was cited. Additionally, during annual inspection, LPA discussed medication training requirement for all those staff administering medications. LPA discussed Health and Safety Code 1569.69 which requires facilities with 15 or fewer residents need ten (10) hours of initial medication training. At today's visit, LPA reviewed training records for S1, S3, S4, and S5. S1 has a total of 39 hours completed including medication training, dementia training, postural supports and restricted conditions, and hospice care. S3 has a total of 42 hours completed including including medication training, dementia training, postural supports and restricted conditions, and hospice care. S4 has a total of 35 hours completed including medication training, dementia training, and hospice care. S4 has not completed postural support and restricted conditions training. S5 has completed a total of 28 hours. LPA and licensee discussed required training subject matters. LPA advised again of Health and Safety Code (HSC) 1569.69 which requires at least ten (10) hours of medication training for all those administering medication to residents. LPA and licensee discussed medication shadowing required for a duration of at least six (6) hours and four (4) hours of other medication training. LPA advised that the approved vendor licensee uses (Community Care Options) can count for the other 4 hours. LPA will clear citation once shadow training log is received as well as postural support training. No citations issued. Exit interview conducted with licensee and a copy of this report given.the state’s words, verbatim · CDSS document, Aug 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by licensee, Martha Marimbi. Facility currently has five (5) residents in care three (3) of which are currently on hospice. At approximately 9:30am LPA and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA 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 and labeled with opened dates present. Locked cabinet in laundry room contains disinfectants and cleaning supplies. 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 111.1 degrees F in the back main bathroom, 115.4 degrees F in room #1, and 111.8 degrees F in room #2 all of which are within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 2/19/26. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted on 3/27/26. Facility has a backup generator for use during a power outage. Martha Marimbi Administrator Certificate 7018478740 expires 3/21/27 All fees are current as of this time. Annual fee due 5/6/26. Fee notification given to Admin along with PIN for online payment. LPA and Licensee discussed Emergency Disaster Plan. Licensee confirmed no updates needed. Continued on 809C... Continued from 809... At approximately 11:00am LPA conducted a review of five (5) out of five (5) resident files. LPA reviewed hospice care plans for three (3) out of three (3) residents currently on hospice. LPA discussed with licensee PRN authorization letter for residents acts as more detailed description of resident ability as observed or required by doctor. LPA discussed with licensee Admission Agreement addendums for those residents that were residents before licensee change. LPA discussed using LIC625 in addition to or instead of LIC603A when documenting the appraisal of residents' care needs after the Pre-Placement appraisal. At approximately 12:30pm LPA conducted review of five (5) staff files. All staff have current 1st Aid/CPR certification. Staff (S1, S3, and S4) all had start dates in 2026 and therefore are required to have 40 hours of training to be completed. S1 has completed 26 hours, S3 has completed 21 hours, and S4 has completed 35 hours. S5's start date was in 2022 and has completed 12 hours of the required 20 hours (deficiency cited, see 809D). LPA discussed medication training requirement for all those staff administering medications. LPA discussed Health and Safety Code 1569.69 which requires facilities with 15 or fewer residents need ten (10) hours of initial medication training. LPA discussed medication regulation and requirements for shadowing. At approximately 1:45pm LPA and Licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked closet. LPA discussed with licensee PRN MAR requirements and that all PRNs must be listed on the Centrally Stored Medication Log (CSML).. 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 Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Apr 29, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Martha Marimbi. Facility contact information was reviewed. Facility mailing address needs to be updated. LPA will update once back in office. Martha Marimbi Administrator Certificate 7018478740 expires 3/21/27. At approximately 9:30am LPA and Admin toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Bag of sugar in pantry had ants crawling both inside and outside of the bag, strawberries in jar had brown fuzzy substance, and bag of Honey Nut Cheerios was open but not sealed or clipped shut (deficiency cited, see 809D). Kitchen drawer with sharp knives locked. Cabinets to the right hand side of kitchen sink both broken, and ceiling vent on hallway heavily covered in dust and debris (deficiency cited, see 809D). 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. Prescription Calmoseptime for R2 in unlocked drawer in bathroom used by most residents (deficiency cited, see 809D). Scissors in unlocked drawer in bathroom used by most residents (deficiency cited, see 809D). LPA observed common towel in resident bathroom. Admin immediately removed and replaced with paper towels. Water temperature in sink accessible to residents in care measured at 118.7 degrees F in the bathroom by the laundry room which is within the allowable range of 105 to 120 degrees F, but measured at 100.5 degrees F in the kitchen and in the hallway bathroom. Admin will contact landlord to get temperature within regulation in all bathrooms and kitchen. Continued on 809C... Continued from 809... Fire extinguishers were last inspected 2/27/25. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted February 2025. Facility has a backup generator for use during a power outage. At approximately 11:30am LPA conducted review of 5 staff records. LPA went over staffing roster with Admin and staffing schedule. S1 has been working since 9/24/24 however, S1 does not have fingerprint clearance. Per Guardian, S1 was determined "not eligible - determination closed.". LPA advised Admin that S1 cannot be present at or working in any capacity at the facility until such time that fingerprint clearance is obtained. S2 has been working since 3/1/22 but as of 1/14/25 they had a rap back and as of 4/8/25 was denied an exemption. LPA advised Admin that S2 cannot be present at or working in any capacity at the facility (deficiency cited, see 809D- civil penalties assessed, see LIC421BG). S3 had one hour of training on file and S4 had 16 hours of training on file (deficiency cited, see 809D). At approximately 1:30pm LPA conducted a review of 6 resident records. All required documentation present. R1 is not on hospice but has unstageable pressure ulcer on left big toe (deficiency cited, see 809D). Admin to submit paperwork to CCL for exception request. Admin to submit care plan and wound care plan as part of paperwork submitted. All documents for pressure ulcer exception to be submitted to CCL no later than 5/22/25. At approximately 2:30pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies. 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, Current Lease Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, May 13, 2025

The state marks this report as 10 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual Inspection and was greeted by Administrator Martha Marimbi. Facility contact information was reviewed. At approximately 9:30am LPA and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Kitchen drawer with sharp knives locked. Food in kitchen refrigerator was found to be stored in a safe manner with open items covered. Food in storage refrigerator had bag of lettuce filled with brown liquid and browning lettuce heads. LPA and Admin observed all non-perishable goods that were checked in storage area to be years beyond the best if used by date (BIYB). Items include: cans of canned fruit with BIYB date of 2021, 2022, and 2023, cake mixes with BIYB of 2020 and 2022, box of quick oats with BIYB of 2023, can of whole tomatoes with BIYB of 2022, several boxes of macaroni and cheese with BIYB of 2022 (deficiency cited, see 809D). LPA and Admin observed laundry room soaps and toxins inside locked laundry room. Laundry room has three doors: one for entry, one leading to a bathroom that resident in room #1 utilizes and the other door leads to the hallway. LPA observed the entry door to be locked, LPA observed the two doors leading out to be locked from the inside; however, laundry room could become accessible to residents, if door accidentally left unlocked. Admin to lock up laundry soaps and toxins in standing cabinet present in laundry room as a precaution. 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 sink accessible to residents in care measured at 105.6, 105.5 and 105.4 degrees F which is within the allowable range of 105 to 120 degrees F. Continued on 809C... Continued from 809C... Fire extinguishers were last inspected 4/2/2024. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational as indicated per Santa Rosa Fire Equipment service sticker dated Jan/2024. Facility’s last quarterly disaster drill conducted 2/5/2024. At approximately 10:15am LPA and Admin observed the following items in need of repair: wooden fence surrounding facility backyard perimeter in disrepair in several different places. LPA and Admin observed vanity in main bathroom to have eroded paint at bottom and exposed particle board with dark brown/black film around the base and in the corner. LPA and Admin observed bathroom in room #3 to has bubbling and lifting linoleum in the left corner by the toilet (deficiency cited, see 809D). At approximately 12:00pm LPA conducted a review of 6 resident records. Appraisal Needs and Services Plan (ANS) for two [2] out of six [6] residents were over one year old; ANS for R1 was dated 1/30/23 and ANS for R2 was 2/6/2023 (deficiency cited, see 809D). At approximately 12:30pm LPA conducted review of 5 staff records. Five [5] out of five [5] staff did not have current 1st Aid/CPR certification (deficiency cited, see 809D). Three [3] out of five [5] staff did not have Health Screens (deficiency cited, see 809D). At approximately 1:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies. Martha Marimbi Administrator Certificate 6051254740 expires 3/21/2025. Fees are due. LPA gave Admin LIS printout with PIN to make payment online. LPA and Administrator discussed facility's Infection Control Plan and Emergency Disaster plan. No new updates. Continued on 809C(2)... Continued from 809C... 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 Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was giventhe state’s words, verbatim · CDSS document, May 9, 2024

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.