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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803936
Report Date: 12/04/2024
Date Signed: 12/04/2024 05:02:42 PM

Document Has Been Signed on 12/04/2024 05:02 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-SONOMA QUALITY CARE HOME LLCFACILITY NUMBER:
496803936
ADMINISTRATOR/
DIRECTOR:
TAPNIO, RYANNEFACILITY TYPE:
740
ADDRESS:4990 FILAMENT CIRCLETELEPHONE:
(707) 595-3766
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 6CENSUS: 5DATE:
12/04/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:43 PM
MET WITH:Ryanne Tapnio-AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Alviso conduct a continued annual inspection, and met with Licensee/Administrator Ryanne Tapnio. Annual was started on 11/5/24.

Facility has a required infection control plan. Facility has a required emergency disaster plan. Facility has an approved hospice waiver for two (2) residents. There is an approved plan of dementia care. Fire clearance is approved for six (6) non-ambulatory, of which one may be bedridden.
Per facility record reviews, emergency disaster drills are being conducted as required. Facility was observed by the LPA to be clean and orderly during the inspection. Food supply was sufficient. Medications were locked and inaccessible to residents in care. Cleaners and disinfectants were locked and inaccessible to residents in care. Sufficient supply of paper products, linens, furnishings, and personal protective equipment (PPE). Facility has a carbon monoxide detector and required smoke alarms. All exits were free and clear of obstruction. All common areas, hallways, bathrooms, and resident rooms had sufficient lighting for residents in care. Facility was at a comfortable temperature.
LPA reviewed five (5) resident files, including medications/medication records.
LPA reviewed three (3) staff files, including staff required training.

LPA is requesting the following documents be updated and submitted by 1/4/2025:
LIC308 - Designation of Administrator Responsibility
LIC500 - Personnel Report
LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required)
Infection Control Plan (ensure to review and update as needed/required)
Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash)
Copy of Current Liability Insurance
Resident Roster
Copy of current Administrator Certificate

There were no deficiencies cited during today's inspection.
Exit interview held with the Administrator.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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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