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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340313203
Report Date: 07/06/2022
Date Signed: 07/06/2022 03:25:26 PM


Document Has Been Signed on 07/06/2022 03:25 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
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:
07/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:36 PM
MET WITH:Gladys and Norminio MangabatTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 07/06/2022 at 2:36 PM. LPA met with Gladys and Norman 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 #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.

LPA Martinez toured the facility on 07/06/2022 at 2:40 PM with Norminio Mangabat.

The facility is sanitary and the furniture is spaced 6 feet apart. The facility conducts daily disinfecting cleaning. The resident bedrooms are furnished and sanitary. The facility bathrooms are in good repair. The facility has an adequate supply of food. The facility smoke and carbon detectors were last inspected in February 2022. The fire extinguisher is in good repair. The exterior of the facility is clear of debris.

The facility submitted a LIC 808 Mitigation plan and and Infection Control plan. The facility has one main screening entry point. The facility conducts daily Covid-19 symptom checks. The facility has a 30 day supply of PPE. The facility has Covid-19 postings throughout the facility. The facility has a designated area for visit.

There were no deficiencies observed or cited at this annual inspection visit. An exit interview was conducted, and a copy of this 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: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022
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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