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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804053
Report Date: 11/17/2025
Date Signed: 11/17/2025 03:55:32 PM

Document Has Been Signed on 11/17/2025 03:55 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:NAPA VALLEY MEMORY CAREFACILITY NUMBER:
286804053
ADMINISTRATOR/
DIRECTOR:		RAGLAND, SHANTIFACILITY TYPE:
740
ADDRESS:903 SARATOGA DRIVETELEPHONE:
(707) 252-7488
CITY:NAPASTATE: CAZIP CODE:
94559
CAPACITY: 44CENSUS: 30DATE:
11/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Shanti Ragland, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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At approximately 10:00 AM, Licensing Program Analysts (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and met with Shanti Ragland, Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) with thirty (30) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for eleven (11), with five (5) Hospice residents currently in care, and is approved for forty-four (44) non-ambulatory residents and ten (10) bedridden resident.

At approximately 10:30 AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one story building, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured between 95.3 degrees F and 139.6 degrees F. LPA informed Administrator that the allowable range is 105 to 120 degrees F per Title 22 regulations. Facility has four (4) separate water heaters and water temperatures vary greatly between faucets closer to each water heater and those further away. Administrator had staff turn up two water heaters where water temperatures tested below the allowable range, and Administrator agreed to post hot water warning signs at every faucet in the facility that tests above the allowable range in order to bring the facility into compliance with regulation. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the courtyard with outdoor space for activities.

LPA observed residents engaged in morning exercises and later engaged in crafting activities. Facility has a monthly activity calendar posted with several activities planned each day.
Continued on LIC809-C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Julie Florio
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2025
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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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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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: NAPA VALLEY MEMORY CARE
FACILITY NUMBER: 286804053
VISIT DATE: 11/17/2025
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Continued from LIC809...

LPA observed a supply of puzzles, games, and crafting supplies available for residents in care. Facility has internet access and Administrator agrees to ensure an internet access device is designated for resident use. Facility telephone was tested an operational during inspection. Facility has several fire extinguishers which were observed charged and were last serviced 07/2025. Facility passed their last fire system inspection and testing conducted by a third party vendor 09/2025. Facility conducts quarterly disaster drills with the last one completed on 10/2025. LPA observed the facility's infection control plan, first aid kit, PPE, flashlights, and emergency supplies. LPA observed a solar panel system and generator for emergency preparedness. LPA reviewed facility's emergency disaster plan which was last updated 05/2024.

At approximately 12:30 PM, LPA conducted file review. LPA reviewed five (5) staff and five (5) resident files and observed the following: five (5) of five (5) staff files reviewed contained the required paperwork including proof of current FA/CPR per regulation. Five (5) of five (5) staff files reviewed were short two (2) hours of Hospice, postural supports, and/or restricted health conditions training. Administrator has scheduled an all staff training for this Friday to ensure facility is brought back into compliance immediately. Five (5) of five (5) resident files reviewed contained the required paperwork per regulation.

At approximately 3:00 PM, LPA reviewed medications and medication records which are maintained and stored in compliance with regulation.

Administrator states that the residents families coordinate residents' medical and dental appointments and transportation to and from visits. However, facility will assist with coordinating these appointments and transportation for residents upon request. Facility does not manage P&I.

Updated copies of the following documents are to be submitted to CCL within 30 days of this visit:
-LIC610E - Emergency Disaster Plan (updated)
-LIC500 Personnel Report (updated)

No deficiencies were cited during today's inspection.
Exit interview conducted with Administrator, whose signature on form confirms receipt.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Julie Florio
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
LIC809 (FAS) - (06/04)
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