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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340313203
Report Date: 07/20/2023
Date Signed: 07/20/2023 02:29:45 PM


Document Has Been Signed on 07/20/2023 02:29 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: 11DATE:
07/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Gladys and Norminio Magabat. TIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 07/20/2023 at 1:20 PM. LPA met with Gladys and Norminio 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 11 residents who reside at this facility.

LPA Martinez toured the facility on 07/20/2023 at 2:00 PM with Norminio Mangabat.

LPA Martinez reviewed six resident files and three staff files; all files were up to date. Facility Liability insurance and surety bond is up to date. Last pest inspection was on July 17, 2023. Fire inspection will be conducted in August of 2023. Fire extinguisher, smoke detectors, and carbon detectors are up to date. Last fire drill was in March, and the facility has a Fire and Disaster Manuel.

The facility water temperature measured at 108 degrees, and resident bedrooms were furnished and in good repair. The facility has a designated area for activities. All common areas of the facilities were in good repair and furnished. The facility has an adequate food supply, and has a supply of drinking water for residents. The exterior of the facility is clean 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 809 report was given to Gladys and Norminio Magabat.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023
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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