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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804120
Report Date: 01/19/2023
Date Signed: 01/19/2023 02:31:42 PM

Document Has Been Signed on 01/19/2023 02:31 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:JEFFERSON, JENEROFACILITY TYPE:
735
ADDRESS:1509 RIO GRANDETELEPHONE:
(310) 531-6049
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
95403
CAPACITY: 6CENSUS: 4DATE:
01/19/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Lead Staff, Rowena RadanaTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 01/19/2023 to conduct a prelicensing inspection. Applicant, Jenero Jefferson was not available in person but was notified over the phone and consented to have LPA perform inspection with staff. This is a change of ownership with clients in care. Facility currently has 4 clients. LPA met with lead staff, Rowena Radana.

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. One bedroom had bed placed on floor, all other bedrooms were personalized for clients with adequate furniture. Client has requested bed be placed on floor, this is addressed in his Individual Program Plan per staff. 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.

Facility shares yard area with neighboring sister facility, the two facilities form a closed compound which allows for movement between facilities. Next door facility is also currently in the process of changing ownership by the same applicant.

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 lead staff, Rowena Radana and a copy of this report emailed to applicant.

No deficiencies observed during today's inspection.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Erik Gonzalez Campos
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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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