<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804041
Report Date: 06/22/2023
Date Signed: 06/22/2023 04:36:18 PM


Document Has Been Signed on 06/22/2023 04:36 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:NAZARETH CLASSIC CARE OF NAPA INCFACILITY NUMBER:
286804041
ADMINISTRATOR:MINERVA VILLEGASFACILITY TYPE:
740
ADDRESS:2465 REDWOOD ROADTELEPHONE:
(510) 468-1909
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:46CENSUS: 22DATE:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Rafael Daatio-Health & Wellnes DirectorTIME COMPLETED:
04:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 6/22/2023 at approximately 3:25pm, and met with Health & Wellness Director(HWD) Rafael Daatio. The HWD contacted the Administrator Minerva Villegas. The Administrator arrived to meet with the LPA.

Hospice care waiver approved for ten(10) residents. Facility has an approved dementia plan of operation. Facility has a required Infection Control Plan, which is part of the facility's plan of operation. Fire clearance approval is for 46 nonambulatory residents, of which 10 may be bedridden.

LPA toured the facility with the HWD. Facility was observed to be at a comfortable temperature. LPA observed exits free from obstruction. LPA observed residents in the large dining area watching a movie. LPA observed that the dinner meal was being prepared for residents. Medications were locked up, and inaccessible to residents in care.

The LPA will continue this Required- 1 Year visit at a later date.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina AlvisoTELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1