<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340313203
Report Date: 07/27/2021
Date Signed: 07/27/2021 11:02:38 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:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Norman Glayds MagabatTIME COMPLETED:
11:10 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 07/27/2021 at 9:45 AM. LPA met with Norman Magabat and stated the purpose of today’s visit. LPA 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 # 6019309740 and expires on 08/13/2022. 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 Norman Magabat on 07/21/2019 at 9:45 AM.

The facility has one central screening entry point. The facility has submitted a LIC 808 mitigation plan and has been approved.The facility has a designated area for visit. The facility has covid-19 postings throughout the facility. The facility has hand sanitizer throughout the facility. The facility common areas, bathrooms, and resident rooms are sanitary and furnished. The facility fire extinguishers are up to date. The exterior of the facility is sanitary and clear of debris.

There were no deficiencies observed or cited at this annual inspection visit. An exit interview was conducted, and a copy of this 808 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: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1