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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032700106
Report Date: 02/09/2023
Date Signed: 02/09/2023 01:39:36 PM

Document Has Been Signed on 02/09/2023 01:39 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ANGELO'S CARE HOMEFACILITY NUMBER:
032700106
ADMINISTRATOR:FERRER, ANGELOFACILITY TYPE:
735
ADDRESS:652 GLENBROOK DRIVETELEPHONE:
(916) 601-9236
CITY:IONESTATE: CAZIP CODE:
95640
CAPACITY: 4CENSUS: 4DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Facility StaffTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct an annual visit. LPA met with facility staff, and discussed the purpose of the visit.

LPA observed two residents in care. According to staff, the other residents were at day program. LPA observed 1 out of 2 residents eating lunch while the other resident was in the room playing music. Staff interactions with residents were very friendly, supportive, accommodating, and encouraging.

LPA toured the facility with staff. LPA observed common areas to be clean and free from debris. Resident rooms were clean and organized with personal touches of each resident. Bathrooms were equipped with soap, paper towels, hand sanitizer, and a lid trash can. The facility has nonperishable foods for a minimum of 7 days and perishable food for 2 days. An emergency supply of food and water was observed. A pull alarm system and fire extinguishers were observed to be charged and within compliance with last check on 11/28/2022. Medications, cleaning supplies, and sharps were locked and inaccessible to residents in care.

LPA requested the following documentation: LIC 500, LIC 308, Surety Bond, and copy of LIC 610

Per California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was left at the facility with facility staff.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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