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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340313203
Report Date: 10/21/2020
Date Signed: 10/21/2020 11:59:25 AM

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:WOODLAKE GUEST HOMEFACILITY NUMBER:
340313203
ADMINISTRATOR:MANGABAT, NORMINIO & GLADYFACILITY TYPE:
740
ADDRESS:1002 LOCHBRAE ROADTELEPHONE:
(916) 649-1082
CITY:SACRAMENTOSTATE: CAZIP CODE:
95815
CAPACITY:14CENSUS: 12DATE:
10/21/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Gladys Mangabat, LicenseeTIME COMPLETED:
12:15 PM
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On October 21 2020 at 11am Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a case management visit. LPA met with Gladys Mangabat, the Licensee and informed her the reason for the visit.

On October 19, 2020 LPA received a email from the licensee informing her that the facility admitted a resident that passed away the next day and was concerned about the death. According to the licensee, the resident was placed by Abounding Love III. The Physician Report should have was sent the same day but was received the next day and did not state important information regarding the resident. The resident had health issues and was on hospice.

LPA and the licensee discussed accepting residents that the facility may not be able to care for. However, in this situation the placing agency and the physician omitted important information that could have benefited the facility.

LPA toured the facility and spoke to residents. Residents are doing well and appeared to be happy.
Per California Code of Regulations, Title 22, no citations were issued .

An exit interview was conducted and a copy of this report was given to Gladys
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2020
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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