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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804119
Report Date: 05/16/2023
Date Signed: 05/16/2023 11:24:45 AM

Document Has Been Signed on 05/16/2023 11:24 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:RAMEILS SACRED CARE HOMES 2FACILITY NUMBER:
286804119
ADMINISTRATOR:JEFFERSON, JENEROFACILITY TYPE:
735
ADDRESS:1513 RIO GRANDETELEPHONE:
(310) 531-6049
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
95403
CAPACITY: 6CENSUS: 5DATE:
05/16/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Applicant Jenero Jefferson & Lead Staff, Rowena RadanaTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced on 05/16/2023 to conduct a pre-licensing inspection. LPA was greeted by lead staff Rowena Radana who called Applicant Jenero Jefferson to attend pre-licensing. Applicant, Jenero Jefferson arrived 2 hours later to complete pre-licensing. This is a change of ownership with clients in care. Fire clearance has been approved for 2 ambulatory and 4 non-ambulatory clients by the County Fire Department. Facility currently has 5 clients.

LPA toured building and grounds which were clean and in good repair. Exits and walkways were free from obstructions. Bathrooms had necessary grab bars and non-slip mats. Facility observed carbon monoxide and smoke detectors throughout the facility. Facility had a sufficient supply of perishable and nonperishable food. Toxins were locked and secured. Medications were locked and secured. First Aid is centrally stored in upper kitchen cabinet.

Facility shares yard area with neighboring sister facility, the two facilities form a closed compound which allows for movement between facilities. Next door facility has changed to new ownership by the same applicant Rameils Sacred Care Home 1- 286804120.

COMP III is waived as licensee operates two other licensed facilities in Sonoma County. LPA will notify application unit to proceed with licensing pending submission of LIC 500. LIC 500 to indicate when administrator is present and which staff are assigned to the facility.

Exit interview conducted with Applicant Jenero Jefferson and a copy of this report given to applicant.

No deficiencies observed during today's inspection.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
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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