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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200744
Report Date: 02/07/2025
Date Signed: 02/07/2025 02:21:49 PM

Document Has Been Signed on 02/07/2025 02:21 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ANGEL WINGS CARE HOME IFACILITY NUMBER:
079200744
ADMINISTRATOR/
DIRECTOR:		ROSE ANCHOLONUFACILITY TYPE:
740
ADDRESS:1403 PREWETT RANCH DRIVETELEPHONE:
(925) 706-2149
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
02/07/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Anita Yabut, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 02/07/25 at 2PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced case management visit for facility closure. LPA explained the purpose of the visit with administrator (ADM).

At 2:10PM, LPA toured the facility with ADM and observed 3 residents living at the facility. ADM stated that there was a change of ownership that occurred on 05/24/24. A new RCFE facility Esther Angels Care Home 079201340 is now operating the facility.
During visit, ADM surrendered their state license to LPA. ADM stated that they decided to close the facility because they wanted to have more time with family.

Exit interview conducted and a copy of this report provided.

Attached is facility closure email sent by administrator on 02/07/25:
Bennett FongTELEPHONE: (510) 622-2621
Daisy PanlilioTELEPHONE: (510) 286-4201
DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
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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