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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803655
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:40:02 PM

Document Has Been Signed on 02/05/2025 01:40 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:MONTE VERDE HOMEFACILITY NUMBER:
496803655
ADMINISTRATOR/
DIRECTOR:		TANEDO, JANET NFACILITY TYPE:
734
ADDRESS:5838 MONTE VERDE DRIVETELEPHONE:
(510) 366-4031
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY: 5CENSUS: DATE:
02/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:03 AM
MET WITH:Janet Tanedo, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:54 PM
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Licensing Program Analysts (LPAs) Christi Coppo and Ali Deniz arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Janet Tanedo. Facility contact information was reviewed.
At approximately 10:00am LPAs toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPAs observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked.

All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. The window sills in bedrooms #1 and #4 had dead flies present. Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks accessible to residents in care measured at 114.6 degrees F in both bathrooms which is within the allowable range of 105 to 120 degrees F.

Fire extinguishers were last inspected 5/8/24. Sprinklers and Smoke/Carbon Monoxide detectors located throughout the facility are serviced by a vendor, last date of service was 8/1/24. Facility’s last quarterly disaster drills were conducted on 1/16/25. Facility has a backup generator for use during a power outage.

Facility has large backyard for outdoor activities but does not have a shaded area present. LPAs and Admin discussed adding a gazebo to provide shade. LPAs observed deck gate to not latch properly. LPAs and Admin discussed repairing gate so that is latches properly.




Continued on 809C...
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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 7
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: MONTE VERDE HOME
FACILITY NUMBER: 496803655
VISIT DATE: 02/05/2025
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Continued from 809...

At approximately 11:30am LPAs conducted a review of five (5) resident records. No deficiencies cited.



At approximately 11:45am LPAs conducted review of five (5) staff records. No deficiencies cited.

At approximately 12:45pm LPAs and Admin reviewed P&I monies. Receipts accounted for, all monies reconciled.

At approximately 1:10pm LPAs and LPT conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies cited.

Janet Tandeo Administrator Certificate 7012316735, submitted for renewal on 9/26/2024 and is currently in Pending renewal status. All fees are current as of this time.



LPAs and Administrator discussed facility's Infection Control Plan and Emergency Disaster plan. No new updates.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:

LIC500- Personnel Report
LIC308- Designation of Responsibility

Exit interview conducted with Administrator and a copy of this report was given.

No deficiencies cited.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC809 (FAS) - (06/04)
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