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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002883
Report Date: 08/20/2024
Date Signed: 08/20/2024 10:26:49 AM

Document Has Been Signed on 08/20/2024 10:26 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
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:CELESTIAL CARE ADULT FACILITY, LLCFACILITY NUMBER:
315002883
ADMINISTRATOR/
DIRECTOR:		YAPDIANGCO, CHARITYFACILITY TYPE:
735
ADDRESS:4136 WEATHERVANE WAYTELEPHONE:
(530) 782-3953
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 4CENSUS: 2DATE:
08/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Charity Yapdiangco, AdministratorTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to complete annual inspection. LPA met with Administrator Charity Yapdiangco during today's inspection. Currently there are 2 clients that reside within the home, and both clients were attending day program during today's inspection.

LPA toured facility with administrator to ensure health and safety of residents in care. LPA toured 4 client rooms, upstairs staff area, 2 bathrooms, kitchen, common living spaces, backyard and the garage area. In the areas toured no immediate health, safety, or personal rights violations were observed. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed an adequate amount of linens and found the first aid kit to be complete.

LPA reviewed 1 of 2 client files and 2 staff files. LPA reviewed medications of one client comparing with physician orders and reviewed 2 clients P&I money. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates and training completed.

During today's inspection no deficiencies were cited.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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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