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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208789
Report Date: 10/27/2021
Date Signed: 10/28/2021 07:54:09 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 6DATE:
10/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:26 PM
MET WITH:Ana Liza Aratea, LicenseeTIME COMPLETED:
04:00 PM
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On 10/27/21, Licensing Program Analyst (LPA) L. Salazar conducted an annual continuation visit. LPA was greeted by licensee and was allowed entry. COVID precautionary measures were taken prior to LPAs entry into facility. LPA toured the facility and observed 6 out 6 residents in care. Three non-ambulatory residents in care were sitting in recliners in the living room, watching TV and three residents were sleeping in their individual rooms when LPA arrived.

LPA provided the following Technical Resource guides for the facility:

Hospice Care
Pressure Injuries
Medication Management


LPA provided licensee with an updated license, changing the Hospice Waiver from six (6) to a Hospice Waiver of one (1). LPA obtained the initial license that was issued and replaced license with updated license. No deficiencies cited on todays visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
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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