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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700554
Report Date: 10/13/2023
Date Signed: 10/13/2023 03:52:09 PM


Document Has Been Signed on 10/13/2023 03:52 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 5DATE:
10/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Angie Crudo, AdministratorTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Angela Hood and the Local Long Term Care Ombudsman arrived at the care home and met with the Administrator, Angie Crudo, to conduct a case management health and safety check regarding a phone call made to the officer of the day.

During today's visit, LPA and the Ombudsman spoke with the Administrator and resident (R1). The Administrator indicted that the health care coverage for all her residents ended and monthly rent payments have not been received from their insurance. The Administrator spoke with all the residents and the residents consented to changing their health insurance in order for rent payments to be made to the facility. R1 was not sure if they wanted to stay at the facility due to their payment amount being increased from the insurance change. R1 wanted until next week to decide whether they will stay at the facility.

The Administrator spoke to LPA and Ombudsman about resident (R2) who is currently receiving hospice services and has a primary diagnosis of Dementia. R2's responsible parties consented to R2's insurance being changed, however, have not provided the insurance card information to the Administrator to set up payment. Administrator was informed to contact Adult Protective Services regarding issue.

No deficiencies are being cited.

Exit interview conducted. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela HoodTELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023
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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