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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804120
Report Date: 12/30/2024
Date Signed: 12/30/2024 12:26:46 PM

Document Has Been Signed on 12/30/2024 12:26 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:RAMEILS SACRED CARE HOMES 1FACILITY NUMBER:
286804120
ADMINISTRATOR/
DIRECTOR:		JEFFERSON, JENEROFACILITY TYPE:
735
ADDRESS:1509 RIO GRANDETELEPHONE:
(310) 531-6049
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
95403
CAPACITY: 6CENSUS: 4DATE:
12/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Ed DavidTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a case management visit. LPA met with House Manager Rowena Radana and Ed David. LPA inquired about the amount of time the Administrator is present at the facility. LPA was informed the Administrator has not come to the facility for some time.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with Ed David and Appeal rights were given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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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Document Has Been Signed on 12/30/2024 12:26 PM - It Cannot Be Edited


Created By: Christopher Arnhold On 12/30/2024 at 11:47 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: RAMEILS SACRED CARE HOMES 1
FACILITY NUMBER: 286804120

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/06/2025
Section Cited
CCR
85064(e)

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(e) The administrator shall be on the premises the number of hours necessary to manage and administer the facility in compliance with applicable law and regulation.
This requirement is not met as evidenced by:Based on interviews conducted and records reviewed, the Licensee did not
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Licensee to submit an LIC500 to show the days and times Administrator will be present at the facility and a written statement from the Licensee stating they understand regulation 85064 and will comply. Written statement and LIC500 shall be submitted to CCL by
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comply with the section cited above. Administrator is not present at the facility to ensure compliance with regulation which poses/posed a potential health, safety or personal rights risk to persons in care.
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POC date of 01/06/2025.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bethany Moellers
LICENSING EVALUATOR NAME:Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:
DATE: 12/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/30/2024


LIC809 (FAS) - (06/04)
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