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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804119
Report Date: 08/08/2023
Date Signed: 08/08/2023 03:18:06 PM

Document Has Been Signed on 08/08/2023 03:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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:
08/08/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:House Manager, Rowena Radana; Administrator, Jenero JeffersonTIME COMPLETED:
03:27 PM
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Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced, to conduct a Post Licensing inspection and was greeted by House Manager, Rowena Radana. Administrator, Jenero Jefferson arrived later but was unable to stay for entire inspection so gave permission for House Manager to sign report.

LPA initiated a tour of the facility around 1:30pm and observed the following: Facility was a comfortable temperature and passageways were free from obstructions. Water temperature in clients' bathroom measured at 107 degrees F which is within allowable range of 105 to 120 degrees F. Cabinet containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked.

Fire extinguisher was last serviced May 2023. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts regular disaster drills and the most recent drill was conducted June 2023.

Six staff files and five client files were reviewed. Staff have required First Aid and CPR certificates. Medications and medication records were reviewed as well as client P&I. Review of facility's Surety Bond showed that client P&I exceeds the amount covered on the Surety Bond. Staff and resident files have not been updated since the recent Change of Ownership.

Continued on LIC809C
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: RAMEILS SACRED CARE HOMES 2
FACILITY NUMBER: 286804119
VISIT DATE: 08/08/2023
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Continued from LI809

Four out of five clients in care are over the age of 59 which is more than fifty percent of the census. Facility must request an exception and was given information on the exception process.

Documents needing to be updated include, but are not limited to, the following:

Clients' Admission Agreements
Proof of staff training
All staff employment documents showing previous Licensee
Surety Bond and LIC400 to reflect accurate amount of cash that is being safeguarded

No deficiencies cited during this inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
LIC809 (FAS) - (06/04)
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