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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002998
Report Date: 10/26/2023
Date Signed: 10/26/2023 12:48:06 PM

Document Has Been Signed on 10/26/2023 12:48 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: 5DATE:
10/26/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Vanessa LomeliTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a post-licensing inspection. LPA met with licensed vocational nurse (LVN), Vanessa Lomeli, and explained the purpose of the visit.

During today's visit, LPA observed the presence of five clients in care, three direct support professionals (DSP), one LVN, and one respiratory therapist (RT).

LPA and LVN conducted a tour of the interior and exterior of the facility to ensure the health and safety of clients in care. LPA observed documentation of daily temperature check for refrigerator. LPA observed facility to have adequate food supply for clients in care. LPA observed the exterior of the facility to be hazardous-free.

LPA and LVN discussed the concerns of California Department of Developmental Services' semi-annual visit conducted on 09/28/2023. LPA and LVN discussed the importance of updating clients' medication orders on file. LPA and LVN further discussed the concerns of variations in activity program was not reflected on the calendar.

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

LPA completed the post licensing CARE tool and found the facility to be in compliance at this time.

Exit interview conducted and a copy of the report was provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023
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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