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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002998
Report Date: 08/16/2023
Date Signed: 08/16/2023 02:57:12 PM

Document Has Been Signed on 08/16/2023 02:57 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: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: DATE:
08/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Ces DongalloTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a case management visit. LPA met with House Manager, Ces Dongallo and explained the purpose of the visit.

During today's visit, LPA observed (5) clients present: one clients in the common area and (4) clients in their private rooms. LPA observed the facility to have adequate staffing: (2) registered nurse, (3) direct support professionals, (1) respiratory therapist, and House Manager.

LPA observed C1 to be smiling. LPA was informed C1 had an "outing" today at Sam's Club. House Manager informed LPA C1 enjoyed picking their own food for the facility. House Manager informed LPA C2 and C3 had an outing the day prior to LPA's visit, to the museum. House Manager reported clients in care are happy to be leaving the community again.

LPA was informed there are no concerns of staffing at the moment. House Manager informed LPA the facility is well staffed with registered nurses as facility is currently training another registered nurse.

As a result of today's visit, 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: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
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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