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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700945
Report Date: 12/03/2024
Date Signed: 12/03/2024 04:25:48 PM

Document Has Been Signed on 12/03/2024 04:25 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WELLCARE HOMES 3FACILITY NUMBER:
342700945
ADMINISTRATOR/
DIRECTOR:
REYNELIZA U CAMALIGFACILITY TYPE:
737
ADDRESS:10799 SIMMERHORN RD.TELEPHONE:
(916) 639-0091
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 4CENSUS: 4DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Jasmine PernellTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required visit. LPA Valerio met with facility staff, and explained the purpose of the visit.

LPA Valerio and Administrator Jasmine Pernell toured the physical plant to ensure compliance with Title 22 regulations. LPA Valerio observed the garage. The garage is being utilized as a staff break room and storage area. LPA Valerio observed the kitchen area to be clean and free from debris. LPA observed all sharps and cleaning supplies to be locked and inaccessible to residents in care. LPA Valerio inspected resident bedrooms. Resident bedrooms were clean, had personalized decorations, and observed to be fully furnished. Resident bathrooms were observed to be sanitary and free from odors. Hot water was measured in the resident bathrooms. One read 108 degrees and the second delivered hot water at 112.3 degrees F. Common areas were observed to be furnished and free from debris. Ukeru pads were observed throughout the home to support staff interventions with residents. The staff office is inaccessible to residents and kept locked. The medication room was observed to be locked and inaccessible to residents in care. The exterior plant was observed to have a space for outdoor visitation and outdoor activities. LPA Valerio observed residents in the kitchen, in the backyard, or in their bedroom. Staff were supervising residents while providing assistance with activities or daily activities. Fire extinguisher, heating and air condition, and carbon monoxide detectors were observed to be compliant and fully operational. The last emergency drill was conducted on October 16, 2024.

LPA Valerio reviewed 2 resident files and 2 staff files. Resident files were observed to be complete and up to date. Staff files were observed to complete with required annual training.

Per California Code of Regulations (CCR) - Title 22 - no deficiencies are being cited on today's visit. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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