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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804053
Report Date: 02/04/2025
Date Signed: 02/04/2025 01:04:48 PM

Document Has Been Signed on 02/04/2025 01:04 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:NAZARETH ROSE GARDEN OF NAPAFACILITY NUMBER:
286804053
ADMINISTRATOR/
DIRECTOR:		RAGLAND, SHANTIFACILITY TYPE:
740
ADDRESS:903 SARATOGA DRIVETELEPHONE:
(707) 252-7488
CITY:NAPASTATE: CAZIP CODE:
94559
CAPACITY: 44CENSUS: 31DATE:
02/04/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Shanti SubbaTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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At approximately 9:15AM, Licensing Program Analyst's Star Stevenson and Chris Arnhold arrived at this facility unannounced to conduct a an annual required continuation inspection. LPA's conducted this case management visit in regards to an allegation of abuse. LPA's met with Administrator Shanti Subba, interviewed staff and reviewed records. Based on interviews conducted, Resident, R1, is a newer resident to the facility. They have a tendency to wander and ended up wandering into Resident's, R2, room. Staff were alerted by R2 that someone was in their room. Staff responded and escorted R1 out of the room. LPA received copies of documents.

The Department will follow up for further details.

No citations issued during this visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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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