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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804273
Report Date: 08/07/2025
Date Signed: 08/07/2025 12:51:19 PM

Document Has Been Signed on 08/07/2025 12:51 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:M & M CARE HOMEFACILITY NUMBER:
486804273
ADMINISTRATOR/
DIRECTOR:		SALVANI, MARIA AFACILITY TYPE:
735
ADDRESS:2046 ORANGE TREE WAYTELEPHONE:
(707) 434-9912
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: DATE:
08/07/2025
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Elizabeth Paras - caregiver with Designation of Facility ResponsibiltiyTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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At approximately 09:45 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a post-licensing inspection and was greeted by Elizabeth Paras - caregiver with Designation of Facility Responsibility (DR). Licensee Maria Salvani was called by phone and reported having facility records in her possession as she continued to finish completion of records and would bring them to the facility for today's inspection. Licensee Maria Salvani was notified of "Statement of Info Due" with the Secretary of State Business division since 06/30/2025

This post-licensing inspection is being conducted after change of ownership from sole proprietorship facility identified as M&M Care Home #486801838 to a corporation ownership structure under the new license of #48604273

Facility is an Adult Residential Facility (ARF). Fire Clearance has been approved for 4 ambulatory clients. Licensee is currently in partnership with North Bay Regional Center (NBRC). Currently M &M care home is caring for 4 clients, 4 of which were away at day programming.

At approximately 10:15 AM , LPA initiated a tour of the facility and observed the following: Facility is a one story home, was a comfortable temperature, odor free and passageways from obstructions. LPA observed required postings including the CCL Complaint Poster and Personal Rights for Individuals with Developmental Disabilities. Water temperatures in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of at least two (2) days of perishable and seven (7) days of nonperishable foods as required by Title 22 Regulations, however LPA noted an expired can food in living room pantry and a technical advisory issued to ensure proper storage of foods, HOWEVER, caregiver was able to point out upon completion of inspection tool that the can had NOT yet expired and I assured her, that no deficiency had been cited and advisory was not needed.
Continued on LIC809-C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2025
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: M & M CARE HOME
FACILITY NUMBER: 486804273
VISIT DATE: 08/07/2025
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...continued from LIC809...
LPA noted a bottle of cleaning spray in a hallway bathroom below a sink that would be accessible to clients in care when they return from day program and a technical violation issue to ensure proper locked storage of toxins and other cleaning products.

LPA observed Emergency lighting and supplies, and first aid kit and facility has an Infection Control plan and Emergency Disaster Plan on file. Smoke and carbon monoxide detectors were tested and operational during today's inspection. Fire extinguisher was observed charged and was last inspected 01/2025. Facility phone was observed operable during today's inspection. The backyard features paved walkways and a patio with a shaded area for client outdoor use. Licensee was advised to raise clothesline above the height the would limit clients and tall guest from easily using backyard spaces. LPA observed large cottage-like structure in the backyard that was noted to contain supplies and other goods.

At approximately 2:00 PM, LPA conducted file review and observed the following: four(4) staff files were reviewed. One (1) of 4 staff files reviewed determined that Staff 1 (S1) was missing physician health screening (LIC503). Otherwise all staff had required documents including evidence of negative TB, 1stAid/CPR and Personnel Record (improved since pre-licensing)

Four (4) of 4 client records were reviewed and all had their Consent for Emergency Medical Treatment (LIC627) as well as their Appraisal Needs and Service Plans (LIC625) in their files (improved since pre-licensing) All requiwed documents were present in clients' files. Medication was observed to be centrally stored and secure. P&I money was centrally stored however, licensee had more client cash on hand that was recorded and a technical violation was issued to ensure better record keeping going forward.

Licensee is ask to submit updated documents of the following by 09/06/2025
1)LIC500 updated personnel roster
2)LIC610D (Emergency Disaster plan with any new personnel, phone numbers etc)

Technical Violations/Advisories are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. No deficiencies are being cited today.

This report was reviewed with Licensee Maria Salvani and DR- Elizabeth "Beth" Paras whose signature here indicates acceptance. Appeal rights were given.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC809 (FAS) - (06/04)
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