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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700237
Report Date: 06/13/2020
Date Signed: 06/13/2020 01:08:05 PM

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:NELLIE'S ANGELS HOME CAREFACILITY NUMBER:
342700237
ADMINISTRATOR:NELLIE JOHNSONFACILITY TYPE:
740
ADDRESS:6730 SKYLANE DRIVETELEPHONE:
(775) 224-6231
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:9CENSUS: 7DATE:
06/13/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Nellie JohnsonTIME COMPLETED:
11:30 AM
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On 6/11/20, Licensing Program Analyst (LPA) Kevin Mknelly, by phone, with Nellie Johnson, Administrator of facility Nellie’s Angels Home Care – 342700237 at approximately 11:00 AM.

The purpose of this inspection was to conduct a health and safety check.

Prior to the inspection, LPA received regarding current resident acuity and staffing status.

LPA conducted a tele-inspection and observed 2 caregivers, and the administrator, for the 7 current clients. All residents were in the physically distanced dining area for lunch. The facility appeared clean and in good repair. LPA video inspected resident living area and bathrooms and did not observe any residents who’s needs appeared to be unattended.

As a result of today’s inspection, no deficiencies were noted.



Unable to obtain signature. Signature present on hard copy in file. LPA sent a copy of report for Nellie Johnson to sign and to send a signed copy back to CCL.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2020
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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