Senior Care Records.

Facility Evaluation Report

Mirabel Lodge, Forestville04/02/2025Licence 496804122

Capacity34
Census33
Date signed04/02/2025 02:15:08 PM
Name of licensing program analystMarisol Cuadra
Name of licensing program managerBethany Moellers
The inspector’s account

Licensing Program Analyst (LPA) Marisol Cuadra arrived unannounced to conduct a Case Management -Other and met with Administrative Assistant, Lisa DiBartolo. The purpose of this case management is to update Fire Clearance received on 3/27/25.

The Facility received an approved fire clearance dated March 27, 2025 that allows for 34 non-ambulatory residents and 7 bedridden might be bedridden rooms as follow: room #1 as single bedroom and room #10, 19, and 20 shared resident bedrooms. However, LPA have noticed that previous fire clearance dated September 26, 2024 was approved to have a secured perimeter.

During today's visit, LPA requested a revised fire clearance indicating the approval of secured perimeter for this facility to generate an updated license reflecting revised items. The facility obtained updated fire clearance including areas of concern were addressed. LPA will update the system and will send an updated license reflecting the changes.

No deficiencies cited during today's visit. Exit interview conducted with Administrative Assistant and copy was given.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction