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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340308207
Report Date: 06/29/2023
Date Signed: 06/29/2023 11:06:39 AM


Document Has Been Signed on 06/29/2023 11:06 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:SACRAMENTO GUEST HOMEFACILITY NUMBER:
340308207
ADMINISTRATOR:MANGABAT, NORMINIOFACILITY TYPE:
740
ADDRESS:2715 G ST.TELEPHONE:
(916) 447-1502
CITY:SACRAMENTOSTATE: CAZIP CODE:
95816
CAPACITY:13CENSUS: 12DATE:
06/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Glayds MagabatTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 06/29/2023 at 9:30 AM. LPA Martinez met with Gladys Magabat and stated the purpose of today’s visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate. The facility is licensed for fourteen ambulatory resident . There are currently 12 residents who reside at this facility.

The LPA toured the facility with the Gladys Magabat on 06/29/2023 at 10:30 AM.

The facility has a designated area for visits. The facility has covid-19 postings and hand sanitizer throughout the facility. The facility has one central screening entry point. The facility common areas, bathrooms, and resident rooms are sanitary and furnished. The facility fire extinguishers and smoke detectors are in good repair. The facility conducted a fire drill in January 2023. The facility has a scheduled fire inspection in August of 2023. The facility has planned activities for residents, and some residents go to a day program. The facility has an adequate food and water supply. The facility has a public phone. The exterior of the facility is sanitary and clear of debris. The facility has a first aid kit, and medications were locked and made inaccessible to resident in care. LPA Martinez reviewed six resident files, and the resident files were complete. LPA Martinez reviewed three staff files, and the staff files were complete.

There were no deficiencies observed or cited at this annual inspection visit. An exit interview was conducted, and a copy of this 809 report was given to Gladys Magabat.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023
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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