ADOM MANOR CARE HOME

2543 TACHEVAH DR, Santa Rosa CA 95405

Facility 496803849 · RESIDENTIAL CARE ELDERLY (740)

6 bedsLatest official report Jun 30, 2026Licensed

Additional info

Telephone: (707) 526-6895
Licensee: ADOM MANOR CARE HOME, LLC
Administrator: KARIKARI, EVA
Contact: KARIKARI, EVA
License first date: Jul 3, 2019
License effective date: Jul 3, 2019
District office: SANTA ROSA RO · (707) 588-5026
Regional office: 21
Clients served: 983 - RCFE / DEMENTIA

Summary

The available records show 1 Type A and 3 Type B deficiencies for this facility.

Most recent inspection: Jun 30, 2026
Most recent deficiency: Jun 30, 2026

No later report is available, so the records do not show what happened afterward.

What Type A and Type B mean

Type A: 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: Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.

Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.

At a glance

Counts cover the five-year public record. Typical figures are the median for the 111 Sonoma County facilities licensed for 6 or fewer beds.

In the available public five-year record, CCLD published 7 reports for this facility: 7 inspections, 0 complaint investigations, and 0 licensing or administrative records.

Those records contain 1 Type A and 3 Type B deficiencies.

0 deficiencies have explicit official correction or clearance evidence in the loaded records.

Official inspections: 7
Recorded deficiencies: 4
Type A deficiencies: 1
Type B deficiencies: 3
Substantiated complaints: 0
Repeated topics: 0

Repeated topics

Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.

No topic repeats in the last 36 months

No deficiency topic appears in more than one report during that window. This does not establish that nothing repeated earlier in the five-year record, and it is not a statement about current conditions.

Official report history

All preserved reports from the most recent to the oldest, sortable by report type.

Jun 30, 2026Inspection

Admission, assessment, and evictionType B

Official classification: Type B
Official code: 87457(a)
Regulation authority: CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and licensee record review, the licensee did not comply with the section cited above in that R3 did not have a current appraisal, needs, and services plan, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2026 Plan of Correction Facility to submit to appraisal, needs, and services plan for R3 by plan of correction due date.

Plan of correction recorded

Correction not verified in available records

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Jul 1, 2025Inspection

Resident rightsType A

Official classification: Type A
Official code: 1569.269(a)(6)
Regulation authority: HSC

What the official deficiency says

§1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation and interview, the licensee did not comply with the section cited above in that R1 requries a two-person assisst but only one staff present at facility, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction Facility to submit to CCL plan to ensure adequate staff such that all residents needing two-person assists are ensured their individual needa are met and delivered by staff that are sufficient in numbers, qualifications, and competency. Licensee to submit LIC500 reflecting adequate staffing by no later thab 7/14/25

Plan of correction recorded

Correction not verified in available records

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Jun 18, 2024Inspection

Licensing and administrationType B

Official classification: Type B
Official code: 1569.618(c)(3)
Regulation authority: HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in that S1 has no current First Aid/CPR Certification, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2024 Plan of Correction Admin to submit to CCL photo of current First Aid/CPR certification by POC due date of 7/2/2024.

Plan of correction recorded

Correction not verified in available records

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Staffing, personnel, and trainingType B

Official classification: Type B
Official code: 1569.625(b)(2)
Regulation authority: HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in that S2, S3, S4, S5 did not have current annual training in the amount of hours required which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2024 Plan of Correction Admin to submit to CCL photo of completed training certificates in the amount of hours required for S2, S3, S4, S5 by POC due date of 07/09/2024.

Plan of correction recorded

Correction not verified in available records

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Jul 11, 2023Inspection

No deficiencies recorded in this report

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Jul 7, 2023Inspection

No deficiencies recorded in this report

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May 26, 2022Inspection

No deficiencies recorded in this report

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Mar 15, 2022Inspection

No deficiencies recorded in this report

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Source and limits

California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.

Read the data methodology