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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803936
Report Date: 09/17/2025
Date Signed: 09/17/2025 05:22:21 PM

Document Has Been Signed on 09/17/2025 05:22 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: 6DATE:
09/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Ryanne Tapnio-AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:40 PM
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Licensing Program Analyst (LPA) Alviso, conduct a Required- 1 Year inspection, on 9/17/25 at about 1:50pm, and met with Administrator Ryanne Tapnio. LPA observed a caregiver,Mielo, on shift upon LPA's arrival. Five residents are in care, and one resident is currently hospitalized.

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.

LPA is requesting the following documents be updated and submitted by 10/17/25
LIC308 - Designation of Administrator Responsibility
LIC500 - Personnel Report
LIC610E 9-pages-Emergency Disaster Plan (review and update as needed/required) Submit if any changes.
Infection Control Plan- (review and update as needed/required) Submit if any changes.
Copy of LIC400 Handling of Client Cash Resources -complete & submit (required form)
Copy of Surety Bond- if handling cash
Copy of Current Liability Insurance
Resident Roster
Copy of Administrator Certificate

LPA and Administrator toured the facility. The LPA observed the following: All exits were free and clear of obstruction. Hot water was measured at 109.4 degrees Fahrenheit, which is within regulation.
Continued on LIC809C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2025
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-SONOMA QUALITY CARE HOME LLC
FACILITY NUMBER: 496803936
VISIT DATE: 09/17/2025
NARRATIVE
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Sufficient supply of linens, cleaners/disinfectants, PPE supplies, and sufficient supply of paper products. Sufficient supply of food for residents in care. Sufficient furnishings for residents use. Sufficient lighting in facility common areas, bathrooms, and resident rooms. Cleaners/disinfectants were locked up and inaccessible to residents in care. Fire extinguishers, two (2) were serviced and tagged as required. Backyard has a large covered deck and the pathway from the ramp to the fire gate is free and clear of any obstructions. The fire gate opened freely.

LPA will continue the annual inspection at a later date. LPA will review files of residents and staff, facility records, and staff training.

LPA observed the following deficiencies. LPA obtained photos.

LPA observed the medication cabinet had the lock on it, and it had the key inserted and hanging in the lock. Resident medications were stored in this cabinet, and all medications were not secure and inaccessible to residents in care. Deficiency cited, 87465(h)(2) Incidental Medical and Dental Care, see LIC809D.

LPA observed that in a drawer in the kitchen were pre-poured medications, pm medications, for residents in care. Regulation does not allow for pre-poured medications, facility is not in compliance. Deficiency cited, 87465(h)(5) Incidental Medical and Dental Care, see LIC809D.

LPA observed food not stored appropriately during the inspection; Food leftovers, cold soup in a small pot on the stove, two plates of food sitting in a cold counter-top oven, and leftover cold rice sitting in a rice cooker on the counter. Three small fruit plates uncovered on a shelf in the refrigerator, and a small uncovered bowl of sliced apple that had turned brown in the refrigerator. LPA observed that food is not being stored appropriately in order to prevent them from potential contamination. Deficiency cited, General Food Service Requirements 87555(b)(9)-see LIC809D.

LPA observed the freezer in the garage to be dirty inside, with food stains, food crumbs, and in need of a deep cleaning. Deficiency will be cited, General Food Service Requirements 87555(b)(21), see LIC809D.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted with Administrator Ryanne Tapnio. Appeal rights provided to the Administrator.

NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/17/2025 05:22 PM - It Cannot Be Edited


Created By: Dina Alviso On 09/17/2025 at 04:40 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: NAPA-SONOMA QUALITY CARE HOME LLC
FACILITY NUMBER: 496803936

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(h)(2)
Incidental Medical and Dental Care- The following requirements shall apply to medications which are centrally stored: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPA observed the medication cabinet had the lock on it, and it had the key inserted and hanging in the lock. Resident medications were stored in this cabinet, and all medications were not secure and inaccessible to residents in care. , the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/18/2025
Plan of Correction
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Licensee to ensure that the medication cabinet that medications are centrally stored in, is locked , secure, and inaccessible to residents in care, and others that do not handle medications. Plan of correction on how facility will comply with this regulation in the future. POC due 9/18/2025.
Type A
Section Cited
CCR
87465(h)(5)
87465 (h)(5) Incidental Medical and Dental Care- The following requirements shall apply to medications which are centrally stored: Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPA observed that in a drawer in the kitchen were pre-poured medications, pm medications, for residents in care. Regulation does not allow for pre-poured medications, facility is not in compliance., the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/18/2025
Plan of Correction
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Licensee to ensure that the medications are not pre-poured in advance, facility to ensure compliance with regulation. Submit plan of correction regarding 87465(h)(5) and staff assisting residents with medications as needed/required. POC due 9/18/25.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Dina Alviso
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/17/2025 05:22 PM - It Cannot Be Edited


Created By: Dina Alviso On 09/17/2025 at 04:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: NAPA-SONOMA QUALITY CARE HOME LLC
FACILITY NUMBER: 496803936

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87555(b)(9)
General Food Service Requirements 87555(b)(9) The following food service requirements shall apply: Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPA observed food not stored appropriately during the inspection; Food leftovers, cold soup in a small pot on the stove, two plates of food sitting in a cold counter-top oven, and leftover cold rice sitting in a rice cooker on the counter. Three small fruit plates uncovered on a shelf in the refrigerator, and a small, uncovered bowl of sliced apple that had turned brown in the refrigerator. LPA observed that food is not being stored appropriately in order to prevent them from potential contamination], the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/18/2025
Plan of Correction
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Licensee to hold an in-service training with staff regarding facility’s storage of food, food preparation, and food services. Submit plan of correction in how the facility will ensure that propper food storage is done by all staff when handling all food in the facility. Submit proof of training by 9/26/25. Proof of training to, include trainer, topics, date, time spent, attendees, and employee signatures. Submit plan of correction by 9/18/25..
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Dina Alviso
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2025


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 09/17/2025 05:22 PM - It Cannot Be Edited


Created By: Dina Alviso On 09/17/2025 at 04:57 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: NAPA-SONOMA QUALITY CARE HOME LLC
FACILITY NUMBER: 496803936

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87555(b)(21)
General Food Service Requirements 87555(b)(21)- Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures.

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPA observed the freezer in the garage to be dirty inside, with food stains, food crumbs, and in need of a deep cleaning. , the licensee did not comply with the section cited above, which poses /posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2025
Plan of Correction
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Licensee to ensure that the freezer is cleaned and a maintainance plan for keeping the freezer/appliances imaintained in a clean manner as needed/required. Submit that this correction has been complete, photos, and future compliance. plan. POC due 9/30/25.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Dina Alviso
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2025


LIC809 (FAS) - (06/04)
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