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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700092
Report Date: 10/19/2023
Date Signed: 10/19/2023 10:17:59 AM

Document Has Been Signed on 10/19/2023 10:17 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:WELLCARE HOMES 1FACILITY NUMBER:
342700092
ADMINISTRATOR:BERNADAS, ANTONIOFACILITY TYPE:
735
ADDRESS:10082 COSBY WAYTELEPHONE:
(916) 647-4573
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 5CENSUS: 4DATE:
10/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Antonio Bernadas - AdministratorTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with administrator and explained the purpose of the visit. Administrator certification #6045737735 expires on 10/24/23. The facility is licensed to serve five (5) clients, ages 18 to 59 years old. There are currently 4 clients who reside at this facility.

LPA toured the facility with administrator. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. The hot water temperature was observed to be 109.3 degrees Fahrenheit, which is within the required regulation of 105 to 120 degrees Fahrenheit. Facility thermostat observed at 74 degrees Fahrenheit. Food supply is adequate for 2 day perishable and 7 day nonperishable. The facility mitigation plan was submitted to community care licensing and it was approved on 2/16/2021. The facility was equipped with smoke and carbon monoxide detectors that met regulation requirements. Fire extinguishers were last inspected on 1/5/2023. Fire Drill conducted on 10/5/2023.

LPA reviewed four staff and two resident files that were locked and readily available for review. Staff had current First Aid/CPR certificates All staff have criminal record clearance and are associated to the facility.

LPA received updated copies of the following documents on today's date:
LIC 308 Designation of Administrative Responsibility, Copy of Administrator Certificate, and Copy of Surety Bond.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit.

Exit interview was conducted with administrator. LIC 811 (Confidential Names) and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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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