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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700237
Report Date: 01/12/2023
Date Signed: 01/12/2023 10:00:53 AM


Document Has Been Signed on 01/12/2023 10:00 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



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: 9DATE:
01/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Staff- Steven Johnson TIME COMPLETED:
10:05 AM
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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 01/12/2023 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with facility staff, Steven Johnson, and explained the purpose of the visit. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility and LPA washed hands.

LPA requested for facility staff to contact Administrator, Nellie Johnson, to inform her that LPA is present at the facility to conduct an annual inspection. Administrator Nellie is currently conducting a pre-licensing inspection at another facility and is unable to meet with LPA.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, six (6) resident bedrooms, four (4) bathrooms, kitchen, garage and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed.

Facility staff, Steven Johnson, arrived at the facility at a later time. LPA and Administrator Nellie Johnson completed the infection control domain via telephone and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and LPA sent a copy of the repot via email.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
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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