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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208789
Report Date: 08/05/2021
Date Signed: 08/05/2021 06:22:16 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SIMPLY CARING ANGELS LLCFACILITY NUMBER:
157208789
ADMINISTRATOR:ANA LIZA P ARATEAFACILITY TYPE:
740
ADDRESS:608 WEST WASP AVENUETELEPHONE:
(760) 793-2307
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:6CENSUS: 5DATE:
08/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:09 PM
MET WITH:Licensee Ana Liza Aratea TIME COMPLETED:
05:00 PM
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Licensing Program Analyst LPA Shawna Doucette and LPA Lisa Salazar conducted an Annual Inspection on this date. LPAs were met by Licensee Ana Liza Aratea and discussed the purpose of the visit. LPAs and Licensee Ana Liza Aratea began the tour at the front entrance/office of the facility.

Licensee does not have a mitigation plan in place. LPA Lisa Salazar emailed Licensee the LIC 808. Visitor log-in and disinfection station was observed upon entry. There was no thermometer at entrance and temperatures were not checked when LPAs entered the facility. Licensee was not wearing a mask in the facility. Facility has one entrance/exit point. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Hand washing and other various Covid-19 related signs were observed in the common areas.

LPA observed a two day supply of perishable food and seven day supply of non-perishable food. LPA observed the following personal protective equipment in facility; masks and gloves. Licensee stated PPE is kept off site. Staff records were reviewed for infection control training. Licensee did not have infection control training for staff. LPA observed all facility staff wearing masks. Resident’s files were not updated for emergency contact information.


Exit interview was conducted and a copy of this report was provided
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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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