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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700554
Report Date: 06/01/2022
Date Signed: 06/01/2022 02:41:21 PM


Document Has Been Signed on 06/01/2022 02:41 PM - 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ANGIES CARE HOMEFACILITY NUMBER:
342700554
ADMINISTRATOR:CRUDO, ANGELINAFACILITY TYPE:
740
ADDRESS:8558 SHERATON DRTELEPHONE:
(916) 962-2460
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 6DATE:
06/01/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Angelina Crudo, Administrator TIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced on 6/1/2022 to conduct a case management inspection to follow up on a Plan of Correction due on 3/31/2022.

LPA met with Angie Crudo, Administrator, and explained the purpose of the visit. LPA also observed Sonia McComic, caregiver, also present.

Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms, and contacted facility and completed a facility risk assessment. LPA ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN-95 Mask.

LPA emailed Administrator two times following due date of 3/31/22 requesting Plan of Corrections be submitted. Administrator indicated she received the second email approximately one week ago.

Administrator wrote a statement per Plan of Corrections and provided to LPA during today's inspection.

LPA toured the facility and observed all (6) residents to be in their rooms napping or watching television. LPA observed the facility to be clean, in good repair and odor free. Inside temperature is 72* F.

Exit interview. Copy of report to be emailed later today along with Plan of Corrections letter
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
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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