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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700237
Report Date: 09/22/2020
Date Signed: 09/22/2020 10:51:16 AM

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:
(916) 729-7648
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:9CENSUS: 8DATE:
09/22/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Nellie JohnsonTIME COMPLETED:
10:35 AM
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On 9/22/20, Licensing Program Analyst (LPA) Kevin Mknelly, by FaceTime, with Nellie Johnson, Administrator of facility Nellie’s Angels Home Care – 342700237 at approximately 9:50 AM.

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

LPA conducted a tele-inspection and observed 2 caregivers, and the administrator, for the 8 current residents. Residents were all physically distanced from one another in various locations. The facility appeared clean and in good repair. LPA video residents resident in care and did not observe any residents who’s needs appeared to be unattended.

LPA and Administrator reviewed and observed staff face coverings use, cleaning and sanitizing procedures, physical distancing for residents, hand washing procedures and their plan for quarantine or isolation if needed. The facility staff are following the recommended staff Covid-19 testing frequency.

To date this facility has had no known or suspected Covid-19 positive staff or residents.

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: 09/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020
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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