<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002998
Report Date: 04/06/2023
Date Signed: 04/06/2023 01:37:31 PM

Document Has Been Signed on 04/06/2023 01:37 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
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:
04/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Vanessa LomeliTIME COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA's) Cassie Yang and Sarah Benson arrived unannounced to conduct a case management visit. LPAs met with licensed vocational nurse (LVN) and explained the purpose of the visit.

During today's visit, LPA's observed (5) residents present in their rooms. LPAs observed the facility to have adequate staffing: (1) registered nurse, (1) licensed vocational nurse, (3) direct support professionals, and 2 respiratory therapist.

LVN informed LPA there are no concerns of staffing at the moment. LVN inquired about masking mandate for Community Care Licensing facilities. LPA informed LVN that informational notices will be sent to Administrator and Licensee regarding masking.

No deficiencies observed.

Exit interview was conducted and a copy of the report was left at the facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1