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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804049
Report Date: 08/28/2026
Date Signed: 08/28/2026 11:42:01 AM

Document Has Been Signed on 08/28/2026 11:42 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 GREENS II LLCFACILITY NUMBER:
496804049
ADMINISTRATOR/
DIRECTOR:		MARIMBI, MARTHAFACILITY TYPE:
740
ADDRESS:805 COUNTRY CLUB DR.TELEPHONE:
(707) 933-8675
CITY:SONOMASTATE: CAZIP CODE:
95476
CAPACITY: 6CENSUS: 5DATE:
08/28/2026
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:18 AM
MET WITH:Martha Marimbi, licenseeTIME VISIT/
INSPECTION COMPLETED:
11:56 AM
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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.

Victoria Bertozzi
Christi Coppo
DATE: 08/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2026
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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