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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803041
Report Date: 11/08/2022
Date Signed: 11/16/2022 01:16:50 PM


Document Has Been Signed on 11/16/2022 01:16 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:LA HOMA GUEST HOME, LLCFACILITY NUMBER:
286803041
ADMINISTRATOR:DASTGHEIB, ALIFACILITY TYPE:
740
ADDRESS:1161 LA HOMA DRIVETELEPHONE:
(707) 252-7426
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:6CENSUS: 5DATE:
11/08/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Licensee Jocelyn Ricasata & Administrator Ali Dastgheib TIME COMPLETED:
02:30 PM
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Regional Manager, Carla Nuti-Martinez, Licensing Program Manager Bethany Moellers, Licensing Program Manager Kimberley Mota, Licensing Program Analyst, Erik Campos-Gonzalez met virtually on a video conference with Licensee Jocelyn Ricasata , Administrator, Ali Dastgheib. The Office Meeting was held to ensure receipt and understanding of the Stipulation and Waiver and Order (Stipulation) (CDSS No. 7222159202) with effective date November 3, 2022. The Stipulation and Waiver was read during this virtual office meeting.

The Default Stipulation and Waiver states in part the following:

Respondent Jocelyn Ricasata license to operate a residential care facility for the elderly located at 1161 La Homa Drive, Napa CA 94558, is revoked with Probation. The revocation of the license shall be STAYED for (2) two years during which time Respondent shall be granted a probationary license with limitations and conditions.

Respondent Jocelyn Ricasata HOSPICE license located at 1161 La Homa Drive, Napa CA 94558, is revoked. Respondent shall not admit a resident needing hospice care. In the event that an existing resident is admitted to hospice, Respondent shall submit an exception request to the Regional Office within 48 hours.

During the probationary period Respondent agrees he or she shall not apply for, receive or hold, an Administrator certificate or any license or certification to operator. Please see Stipulation and Waiver #CDSS No. 7222159202 for additional terms of probation.


Facility to follow regulations issuing eviction notices and providing residents and any responsible parties a copy of the Default Decision and Order.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
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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