<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208789
Report Date: 08/26/2021
Date Signed: 08/26/2021 11:10:05 AM

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: 4DATE:
08/26/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Licensee, Ana Liza ArateaTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An Informal Office Meeting/ Conference call was held on 08/26/2021 at the Fresno Regional Office. The informal conference process was explained during this meeting.

The following were in attendance:

ANA LIZA ARATEA, Licensee,
BRENDA WHITE, Regional Manager,
MELINDA HOFFMANN, Licensing Program Manager I,
LISA SALAZAR, Licensing Program Analyst
SHAWNA DOUCETTE, Licensing Program Analyst

The purpose of the informal meeting/conference meeting was to discuss recent deficiencies and the necessity of bringing the facility back into compliance. Additionally, the following was discussed:

Site inspections will increase to monitor compliance;
Necessity of submitting Incident and Death reports via fax or USPS mail;
Request to submit updated LIC 9020 for each new resident on monthly basis;
Hospice Waiver will be decreased from 6 to 1;
Eviction Procedures/Regulations were provided to licensee regarding R1.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1