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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216801977
Report Date: 10/22/2026
Date Signed: 10/22/2026 02:36:52 PM

Document Has Been Signed on 10/22/2026 02:36 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:STOCKSTILL HOUSEFACILITY NUMBER:
216801977
ADMINISTRATOR/
DIRECTOR:		NATALIA MEYERSONFACILITY TYPE:
740
ADDRESS:12051 STATE ROUTE 1TELEPHONE:
(415) 663-0722
CITY:POINT REYES STATIONSTATE: CAZIP CODE:
94956
CAPACITY: 8CENSUS: 6DATE:
10/22/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Natalia Meyerson, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:51 PM
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Natalia Meyerson, Administrator. Administrator (Admin) Certificate Natalia Meyerson 7001474338740 expires 5/17/28. Facility currently has six (6) residents in care one (1) of which is currently on hospice.

At approximately 10:00am LPA and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. LPA and Admin observed: multiple cartons of cranberry and mixed berry juice to have expiration dates of April and May 2026, cartons of Pacific butternut squash soups to have expiration dates of April and May 2026, and carton of organic chicken broth had expiration date of February 2026. LPA and Admin observed box of CrunchMaster crackers to be open and unsealed, and multiple boxes of crackers such as Ritz and Triscuit with expiration dates of April 2025, May 2025 and January 2026, box of Annie's Organic crackers with expiration date of November of 2024, and 2 boxes of microwave popcorn with expiration date of April 2024 (deficiency cited, see 809D). Admin explained they get food donations from community and from the food bank. LPA advised to be sure to check all donated food for expiration dates.

Kitchen cabinet under sink contains disinfectants and cleaning supplies. Cabinet has magnetic locking mechanism. All other cleaning products and laundry soaps are located in the garage and inaccessible to residents in care. Admin explained to LPA that hall closet light works for a night light. LPA discussed with Admin that night lights could be added to hallways for safety. Fireplace present and properly screened.

Continued on 809C...
Victoria Bertozzi
Christi Coppo
DATE: 10/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2026
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: STOCKSTILL HOUSE
FACILITY NUMBER: 216801977
VISIT DATE: 10/22/2026
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Continued from 809...

All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean. Room #4 has window on right hand side that will not open, both Admin and LPA tried to open it but were not successful. LPA and Admin observed wood siding underneath south facing deck to be separated from building and splintered wood leaving grate hanging and green and gray fuzzy substance present. Admin will work with landlord West Marin Senior Service to get repaired immediately.

Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 111.7 degrees F in the kitchen and 110.9 in the bathroom used by residents, both of which are within the allowable range of 105 to 120 degrees F. Facility has another bathroom used by staff only. Fire extinguishers were last inspected 07/30/26. Smoke detectors located throughout the facility are serviced by ADP. LPA reviewed service report, all equipment passed and is operational. Additional Carbon Monoxide detector present in hall. Facility’s last quarterly disaster drill was conducted on August 2026. Facility has a backup generator for use during a power outage.

At approximately 12:00pm LPA conducted a review of four (4) out of four (4) staff files and six (6) out of six (6) resident files. No deficiencies cited. At approximately 1:15pm LPA and Admin conducted a spot check of medication and medication records. LPA went over PRN MARs requirements and printed 87465 regulation for Admin reference. LPA advised Admin that it is a good idea to record dates started and write the dates started on the actual bottle. LPA advised that all current doctors' orders must be signed and present in the residents' file at all time. If a medication is discontinued, then Admin must keep the discontinuation on file as well.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:
LIC500- Personnel Report

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.
NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/22/2026 02:36 PM - It Cannot Be Edited


Created By: Christi Coppo On 10/22/2026 at 02:16 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: STOCKSTILL HOUSE
FACILITY NUMBER: 216801977

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87555(b)(8)
General Food Service Requirements
(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA and Admin observation, the licensee did not comply with the section cited above in that LPA and Admin observed: multiple cartons of cranberry and mixed berry juice to have expiration dates of April and May 2026, cartons of Pacific butternut squash soups to have expiration dates of April and May 2026, and carton of organic chicken broth had expiration date of February 2026. LPA and Admin observed box of CrunchMaster crackers to be open and unsealed, and multiple boxes of crackers such as Ritz and Triscuit with expiration dates of April 2025, May 2025 and January 2026, box of Annie's Organic crackers with expiration date of November of 2024, and 2 boxes of microwave popcorn with expiration date of April 2024, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/26/2026
Plan of Correction
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Facility Admin and caregiver went through pantry items and discarded all expired items while LPA present. Deficiency cleared.
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.
Victoria Bertozzi
NAME OF LICENSING PROGRAM MANAGER:
Christi Coppo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2026


LIC809 (FAS) - (06/04)
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