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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804286
Report Date: 11/06/2025
Date Signed: 11/06/2025 12:33:08 PM

Document Has Been Signed on 11/06/2025 12:33 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:NEEMA HOMES LLCFACILITY NUMBER:
486804286
ADMINISTRATOR/
DIRECTOR:		NGATA, STEPHENFACILITY TYPE:
735
ADDRESS:1001 YATELEY COURTTELEPHONE:
(562) 353-0990
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 4CENSUS: 3DATE:
11/06/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Stephen Ngata-Administrator TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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At approximately 10:00am, Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a case management visit in regards to two incident reports submitted to CCL from the facility. LPA was greeted by administrator (admin) Stephen Ngata.

On 10/30/2025 CCL received incident report involving client (C1) for an incident that occurred on 10/29/2025. C1 eloped from the facility during the night. Facility received a call from Vacaville PD that client was found and was in their custody. C1 was reported to be found wandering around and was placed in a hotel. At 6:55am Vacaville PD dropped off C1 back at the facility. Admin stated both night staff were immediately suspended and will no longer be working at facility.LPA conducted interviews and gathered additional documents. Facility is being cited for not providing the services necessary to meet clients needs as evidenced by a lack of supervision which led to C1's elopement from the facility (Deficiency cited, See LIC809-D).
*Civil Penalty Issued for $500 per HSC 1548(c)(3)

On 10/30/2025 CCL received incident report involving client (C1) for an incident that occurred on 10/28/2025. Staff did not administer C1 scheduled 8pm medication. Admin stated C1 was in shower during medication pass and medication was seen to not have been administered the following morning (Deficiency cited, See LIC809-D).

Technical Support Provider (TSP) assistance was offered to Licensee during visit. Licensee would like to participate in TSP and follow through with program.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiencies, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted with Administrator and appeal of rights provided. .

NAME OF LICENSING PROGRAM MANAGER: Kimberley Mota
NAME OF LICENSING PROGRAM ANALYST: Ethel Contreras
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025
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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Document Has Been Signed on 11/06/2025 12:33 PM - It Cannot Be Edited


Created By: Ethel Contreras On 11/06/2025 at 10:40 AM
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: NEEMA HOMES LLC
FACILITY NUMBER: 486804286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2025
Section Cited
CCR
85078(a)

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80078(a) Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement isn't met as evidenced by:
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 Facility agrees to conduct staff training regarding elopement, & wandering behaviors Proof of staff training w/participants signature, trainer signature, what was covered, & date of training to be submitted to CCL by 11/20/2025.
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Based on interview & records review facility staff didn't comply w/this section for 1 of 1 client which poses an immediate Health, Safet yor personal rights risk to client in care. Client C1 eloped in the night and was found by Vacaville PD.
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Facility to submit self-certification that clients will be supervised & kept safe by POC date 11/07/2025.
*Civil Penalty Issued for $500 per HSC 1548(c)(3)
Type B
11/07/2025
Section Cited
CCR80075(b)

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80075(b) Health Related Services: Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement was not met as evidenced by: Based on review of incident reports, and interview
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Licensee to submit self-certification that training will be conducted for all staff that administer medications by POC Due Date of 11/10/2025. Training to include Date,Topic, Staff Names, Staff Role, and Signatures. Proof of training/supporting documents to be submitted by POC Due Date of 11/20/2025
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Licensee did not comply with the section cited above and did not ensure that Client 1 receive their night medication.
This poses an immediate health, safety or personal rights risk to persons in care.
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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.
Kimberley Mota
NAME OF LICENSING PROGRAM MANAGER:
Ethel Contreras
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2025


LIC809 (FAS) - (06/04)
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