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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200994
Report Date: 11/14/2020
Date Signed: 11/14/2020 11:56:09 AM

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:ANGELS TOUCH CARE HOME, LLCFACILITY NUMBER:
079200994
ADMINISTRATOR:ROSS, LARUTHFACILITY TYPE:
740
ADDRESS:1653 SWALLOW WAYTELEPHONE:
(510) 725-2020
CITY:HERCULESSTATE: CAZIP CODE:
94547
CAPACITY:6CENSUS: 0DATE:
11/14/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Laruth Ross, AdministratorTIME COMPLETED:
11:56 AM
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On 11/14/20 at 11:00AM, Licensing Program Analyst (LPA) J. Hamilton conducted an pre-licensing inspection with facility Administrator, Laruth Ross. Due to the Governor's shelter-in-place order this inspection was conducted via videoconference.

LPA toured facility with Administrator, including but not limited to residents' bedrooms, common living area, dinning room, kitchen, laundry room, and outdoor areas. Resident bedrooms are equipped with proper furniture and bedding. LPA observed lighting in all rooms is adequate for the comfort and safety of residents. The kitchen was observed clean and within compliance. LPA observed at least a one week supply of non-perishable and 2-day supply of perishable foods. Bathrooms were equipped with grab bars and non-skid mats. Administrator acknowledged hot water temperature should be maintained between 105 and 120 degrees F. Living room is equipped with proper for furniture residents. There are designated secure storage areas for chemicals, medications, and sharp utensils. Indoor and outdoor passageways observed to be free of obstruction. LPA noted fire extinguisher last inspected August, 2020. Facility is equipped with a fully stocked first-aid kit. LPA observed smoke detectors throughout the home, and an operational carbon monoxide detector.

Component III has been waived. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Administrator by telephone. LPA will email a copy of this report to the Administrator on today's date.
SUPERVISOR'S NAME: Isaac TaggartTELEPHONE: (510) 622-2610
LICENSING EVALUATOR NAME: Jason HamiltonTELEPHONE: (510) 622-2647
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2020
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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