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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700237
Report Date: 01/08/2025
Date Signed: 01/08/2025 11:12:42 AM

Document Has Been Signed on 01/08/2025 11:12 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NELLIE'S ANGELS HOME CAREFACILITY NUMBER:
342700237
ADMINISTRATOR/
DIRECTOR:		NELLIE JOHNSONFACILITY TYPE:
740
ADDRESS:6730 SKYLANE DRIVETELEPHONE:
(916) 729-7648
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 9TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
01/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator- Nellie Johnson TIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 01/08/2025 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required 1 year annual inspection. LPA met with Administrator Nellie Johnson and explained the purpose of the visit.

LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: resident bedrooms, bathrooms, kitchen, backyard, garage, and the common areas. LPA observed sufficient furniture and lighting throughout the facility. LPA observed there is sufficient food supplies for seven (7) day non-perishable and two (2) day perishable. LPA observed toxins and knives to be locked and inaccessible to residents in care. LPA also observed centrally stored medications are kept locked and inaccessible to residents. The fire extinguisher located in the kitchen was last inspected on 09/11/24. Smoke detectors are current and in compliance with fire safety including carbon monoxide detector.

LPA reviewed five (5) resident files and two (2) staff files all files contained the required documents.

LPA Ratajczak requested Administrator to send updated copies of the following by 01/15/2025 to LPA
  • Administrator Certificate
  • LIC308- Designation of Administrative Responsibility
  • Liability insurance
  • LIC500- Personnel Report

No deficiencies being cited during today's inspection.

Exit interview conducted and report provided
Laura MunozTELEPHONE: (916) 263-4743
Cheyenne RatajczakTELEPHONE: (916) 969-7879
DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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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