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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803675
Report Date: 03/12/2025
Date Signed: 03/12/2025 02:53:38 PM

Document Has Been Signed on 03/12/2025 02:53 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:ASSISTED LIVING OF NAPA VALLEY-HAMILTONFACILITY NUMBER:
286803675
ADMINISTRATOR/
DIRECTOR:		ARNKE,CHRISTINEFACILITY TYPE:
740
ADDRESS:3100 HAMILTON STREETTELEPHONE:
(707) 312-2971
CITY:NAPASTATE: CAZIP CODE:
94559
CAPACITY: 6CENSUS: 6DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Christine Arnke, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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At approximately 12:25 PM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Staff. Administrator Christine Arnke arrived at approximately 12:30 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for six (6), with five (5) Hospice residents currently in care, and is approved for five (5) non-ambulatory residents, and one (1) bedridden.

At approximately 12:40 PM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one-story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 10/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperatures measured 119.4 degrees F and 107.5 degrees F which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked.

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. There is a shaded seating area in the backyard with outdoor space for activities. LPA was informed that facility hosts various live musical performances by choirs and students on a regular basis as well taking residents for walks in the community. Facility has an internet access device designated for resident use and internet service available.

Continued 809C...
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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: ASSISTED LIVING OF NAPA VALLEY-HAMILTON
FACILITY NUMBER: 286803675
VISIT DATE: 03/12/2025
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At approximately 1:30 PM LPA conducted review of five (5) staff records. All required documentation present.


At approximately 2:00 PM LPA conducted a review of five (5) resident records. All required documentation present.


At approximately 2:30 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked.

Christine Arnke Administrator Certificate 702438740 expires 08/08/2025. All fees are current as of this time.



LPA and Administrator discussed facility's Emergency Disaster plan, No new updates. Facility’s last quarterly disaster drill was conducted on 1/2025.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:

Liability Insurance
LIC500- Personnel Report
LIC308- Designation of Responsibility
LIC604 – Admission Agreement (blank form)

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

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC809 (FAS) - (06/04)
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