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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340313203
Report Date: 06/16/2024
Date Signed: 06/17/2024 10:54:47 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/17/2024 10:54 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: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: 10DATE:
06/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:GLADYS MANGABAT - ADMINISTRATORTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with administrator and stated the purpose of today’s visit.

LPA and administrator toured the physical plant including resident bedrooms, resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present.



LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 110.2 degrees Fahrenheit in resident bathroom sink which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguishers last serviced 8/24/2023. LPA checked medication storage and found medication to be locked away and inaccessible to residents. First aid kit was checked and is complete. Fire/Emergency Disaster Drill last conducted 4/20/2024.

LPA reviewed five resident files and two staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews.

As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22.

Exit interview held with administrator. A copy of report and LIC 811 (Confidential Names) given at the conclusion of this visit.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2024
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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