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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804273
Report Date: 02/19/2026
Date Signed: 02/19/2026 12:25:38 PM

Document Has Been Signed on 02/19/2026 12:25 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:
02/19/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Maria Salvani-AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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At approximately 10:15 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by Elizabeth Paras - caregiver with Designation of Facility Responsibility (RP). Licensee Maria Salvani was called by phone and arrived at approximately 10:30 AM to further assist with today's inspection.

Facility is an Adult Residential Facility (ARF) with a fire clearance approval for 4 ambulatory clients. Licensee is currently in partnership with North Bay Regional Center (NBRC). Currently M &M Care Home is caring for four (4) clients, 4 of which were away at day programming during today's inspection.

At approximately 10:45 AM , LPA initiated a tour of the facility and observed the following: Facility is a one story home, was a comfortable temperature, free of odors and passageways free 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.

LPA observed Emergency lighting and supplies, and first aid kit and facility has an Infection Control plan and Emergency Disaster Plan on file. The LIC610D Emergency and Disaster Plan was updated 01/2026. Smoke and carbon monoxide detectors were tested and operational during today's inspection. Fire extinguisher was observed charged and was last inspected 01/2026. 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. LPA observed a large cottage-like structure in the backyard that was noted to contain supplies and other goods.
Continued on LIC809-C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2026
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: M & M CARE HOME
FACILITY NUMBER: 486804273
VISIT DATE: 02/19/2026
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...continued from LIC809...

At approximately 11:00 AM, LPA conducted file review and observed the following: four(4) staff files were reviewed and all 4 had required documentation.

At approximately 11:30 AM, Four (4) of 4 client records were reviewed and also found to have all required documentation.

Medication was observed to be centrally stored and secure.

P&I money was found to be secure and appropriate for their Surety Bond however, the licensee had slightly more resources on hand than the LIC400 (Affidavit for Client Cash Resources) and Licensee was asked to submit the correct LIC400 for client cash managed.

Facility recently submitted the following document to update the facility file:
1)LIC500 updated personnel roster (updated 01/23/2026)
2)LIC9020 has not had changes since recent post-licensing inspection on 08/07/2025

LPA obtained the following document today to update the facility file:
1)LIC610D (Emergency Disaster plan)

No deficiencies are being cited today.

This report was reviewed with Licensee Maria Salvani, whose signature denotes receipt.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
LIC809 (FAS) - (06/04)
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