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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002998
Report Date: 01/18/2023
Date Signed: 01/18/2023 11:50:04 AM

Document Has Been Signed on 01/18/2023 11:50 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:WELLCARE HOMES 4 - ENGLE HOMEFACILITY NUMBER:
345002998
ADMINISTRATOR:QUIROZ, VENETHFACILITY TYPE:
734
ADDRESS:5029 ENGLE RDTELEPHONE:
(916) 230-4087
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 5CENSUS: 5DATE:
01/18/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Ces DongalloTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Cassie Yang arrived to the facility to conduct a pre-licensing inspection for change of ownership. LPA spoke with Licensee, Robert Hernandez, who explained the inspection will be conducted with House Manager, Ces Dongallo. Prior to entering the facility, LPA worn a surgical mask and was screened at entrance by House Manager. Today's census is five.

LPA and House Manager toured the interior and exterior of the facility to ensure the health and safety of clients in care. Areas toured included but not limited to: common areas, kitchen, laundry room, clients rooms, shower room and the backyard. In the areas toured, no immediate health, safety or personal rights violation was observed.

LPA observed 5 out of 5 clients and 1 House Manager, 1 licensed vocational nurse, 3 direct support professionals, and 1 respiratory therapist to be present in the facility. LPA observed the facility to have 2+ days of perishables and 7+ days of non-perishable foods in stock. LPA observed medication, toxicants, and sharps to be locked and secured. LPA observed the facility to have Ombudsman, CCLD If You See Something, and Covid-19 posters posted throughout the facility. LPA observed the fire extinguisher to be last serviced on 8/22/2022. LPA observed the refrigerator to be temperature checked early in the day at 40* degrees. LPA observed the bathroom to have hand washing signs posted, hand soap, and trash can with lid.

As a result of today's visit, no deficiencies were observed.

Comp III has been waived by Licensee as Licensee and Administrator has worked in other facilities licensed by CCLD.

Exit interview conducted with House Manager and a copy of the report will be emailed to Licensee.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023
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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