Home Sweet Home of Napa

Type of visit: Required - 1 Year

At approximately 10:30 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and met with Raymond A. Go, Designated Responsible Party (DRP). Licensee/Administrator was contacted via telephone and was unable to attend today's inspection. Facility is an Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. The community has a Hospice waiver for six (6) and is approved for one (1) bedridden resident. At approximately 11:00 AM, LPA initiated a tour of the community with DRP and observed the following: Facility is a one story building and was a comfortable temperature. Water temperature in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of paper products available to clients. Closets containing cleaning supplies and other items that could pose a risk were locked. The community has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There are covered seating areas and outdoor space for activities. Facility has internet service and a designated internet access device available to for resident use. The community's fire extinguishers were observed charged and were last serviced 07/2026. smoke and Carbon Monoxide detectors were tested operational during today's inspection. Facility conducts quarterly emergency/disaster drills with the last one conducted 05/2026. LPA observed facility's infection control plan and emergency disaster plan which was last updated 11/2023. LPA observed a supply of PPE, emergency supplies, flashlights and a first aid kits throughout the community. continued on LIC809C... Continued from LIC809... Based on the facility sketch and fire clearance dated January 13, 2025, resident room #1 is cleared for two residents and has two exits. There are no additional structures or modifications pictured on the sketch or mentioned in the clearance. During facility walk through, LPA observed resident room #1 with a half wall and an accordion door installed and latched closed at the top near the ceiling on one side and a night stand and bedside commode placed in front of the door obstructing it, and preventing the rear resident from exiting through the main doorway, (see LIC809D and LIC421IM). At approximately 12:30 PM, LPA reviewed five (5) resident records and five (5) staff records. Two (2) out of five (5) resident's records were observed missing a current physician's report and proof of negative TB results, (see LIC809Ds). Five (5) out of five (5) resident records reviewed were observed to contain the remaining required documents. Five (5) out of five (5) staff records have the required paperwork and proof of current First Aid/CPR certification. However, three (3) out of five (5) staff files reviewed were observed missing proof of all of the required initial training hours and proof of all of the required initial medication training hours, (see LIC809Ds). Medication and medication records were reviewed and were observed managed and stored in compliance with regulation. Facility works with residents and their families to coordinate medical and dental visits as well as transportation to and from appointments. Facility does not manage P&I cash resources. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: -LIC610E - Emergency Disaster Plan (updated) Deficiencies are being cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the deficiencies by the plan of correction date and/or repeat deficiencies within a 12 month period may result in civil penalties. **An Immediate Civil Penalty in the total amount of $500 is being assessed for the observed latched accordion door in resident room #1 which was latched near the top and obstructed by a night stand and bedside commode, which is a fire clearance violation and immediate health, safety, and/or personal rights violation to persons in care. (See LIC421IM).** Exit interview conducted with DRP whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Jul 27, 2026

Type of visit: Prelicensing

At approximately 9:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived announced to conduct a pre-licensing inspection and was greeted by House Manager, Raymond Go. Ali Sina Dastghheib, Licensee/Administrator was contacted via telephone, gave permission to begin inspection with House Manager, and arrived approximately 90 minutes later. This pre-licensing inspection is being conducted for a change of ownership licensing of a Residential Care Facility for the Elderly (RCFE). Fire Clearance has been approved for 5 non-ambulatory and 1 bedridden resident. Licensee/Administrator applied for a Hospice waiver for 2 which is being reviewed and has a dementia care plan. Licensee/Applicant works with a placement agency. There were 5 residents in care during today's inspection. At approximately 9:30 AM, LPA initiated a tour of the facility with House Manager and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed resident showers with the required non-slip mats and grab bars in place. LPA observed a supply of clean linens, hygiene products, incontinent care products, and paper products available for residents. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. There was a sufficient amount of dishes and cooking supplies for resident use with sharps and other hazardous items kept secured in various designated drawers and cabinets as well as under the kitchen sink. Continued on LIC809-C... ...continued from LIC809... Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable foods, one week of non-perishable foods, and an emergency water supply. LPA observed a sample menu posted in the common area to indicate a healthy and balanced set of meals for residents in care. The facility telephone was tested and is operational. Facility has internet services and an internet access device designated for resident use. Facility has a designated locked closet for centrally stored medications and resident, staff, and facility files. LPA observed the facility's infection control plan, first aid kits, PPE, other emergency supplies, and an activity schedule. LPA recommended increasing activity supplies and frequency. The backyard features a deck and paved patio area with shaded seating for resident outdoor use. Windows, screens, and blinds are all found to be in good repair. Facility has 2 fire extinguishers, which were last inspected 06/2024 and are fully charged. Facility has a third party company scheduled for 7/7/2025 to service extinguishers. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Licensee/Applicant has posted hard copies of the emergency disaster plan and maps, personal rights information, local ombudsman information, and the CCLD reporting poster in facility communal areas. The facility currently has Licensee/Applicant and one staff member associated to facility. Other staff are cleared and associated under the existing facility and Licensee/Applicant agreed to associate the staff to the new facility license with Guardian. Licensee has been informed of association and staff transfer process. A sampling of staff and resident files were reviewed and found to be in compliance with regulation. Medications and medication records were inspected and found stored and maintained in compliance with regulation. Licensee/Applicant submitted a copy of the facility's lease agreement to the Centralized Application Bureau and will submit proof of liability insurance once plan is active post licensure. LPA observed a facility sketch which accurately reflects the floor plan. LPA observed three structures in the backyard which are noted on facility sketch but the fire department inspector did not specify the approved use of any as living quarters. LPA contacted Fire Inspector for clarification. Licensure pending confirmation that the blue and white structure is approved as living quarters for staff as observed with made bunk beds, furniture, clothing, and personal items during today's inspection. Component III orientation was conducted with the Licensee/Applicant at facility where they conveyed knowledge and understanding of Title 22 regulations. The pre-licensing evaluation has been completed. Exit interview conducted with Applicant, whose signature on this document confirms receipt.the state’s words, verbatim · CDSS document, Jul 3, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Ali Sina Dastgheib (CEO/Administrator) Interview Method: Virtual interview via Microsoft Teams On May 29, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 29, 2025