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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920018
Report Date: 09/07/2023
Date Signed: 09/07/2023 02:44:14 PM

Document Has Been Signed on 09/07/2023 02:44 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
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:ANGEL CARES HOME 2, INC.FACILITY NUMBER:
315920018
ADMINISTRATOR:CENTENO, CRISELDAFACILITY TYPE:
735
ADDRESS:1225 CANEVARI DR.TELEPHONE:
(916) 519-7474
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 4CENSUS: 0DATE:
09/07/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Criselda Centeno, LicenseeTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived to conduct a pre-licensing inspection. LPA met with licensee Criselda Centeno during today's visit. Currently there are no clients residing within the facility.

Facility was inspected both indoors and outdoors. LPA inspected 4 client bedrooms, 3 bathrooms, 1 staff office, common living areas, garage and kitchen. Outdoor area is free from hazardous debris. Outdoor exits are clear and accessible. Licensee has purchased an outdoor patio set with a shade covering, and it will be delivered prior to client move in. First aid kit was present in the facility. Centrally stored medications will be locked in the staff office. The facility has adequate lighting throughout. Water temperature was observed at 114 degrees F. LPA inspected client bedrooms and the bedroom had appropriate furnishings, chair, adequate lighting and storage. Bathrooms are clean, sanitary, and in good repair. Smoke detectors and carbon monoxide detectors were operational. Fire clearance was granted on 05/18/2023 for 4 non-ambulatory clients. Kitchen is clean, sanitary, and in good repair. A working telephone has been set up for client use.

Licensee agrees to notify LPA once first consumer is admitted. This report will be forwarded to the centralized application unit for continued processing. COMP III was waived.

Exit interview and copy of report provided.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
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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