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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002998
Report Date: 01/24/2024
Date Signed: 01/24/2024 02:13:57 PM

Document Has Been Signed on 01/24/2024 02:13 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: 4DATE:
01/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Veneth QuirozTIME COMPLETED:
02:05 PM
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced on 01/24/2024 to conduct an annual inspection. LPA met with Administrator, Veneth Quiroz, and explained the purpose of the visit.

Facility is licensed for five non ambulatory clients, today's census is five. LPA observed facility to be staffed with three direct support professionals, one respiratory therapist, one licensed vocational nurse, and a registered nurse.

LPA and Administrator conducted a tour of the facility. Areas toured included but not limited to: five clients room, shower room, laundry room, bathroom, kitchen and common areas. LPA observed facility to be at 73*. Administrator Certificate posted to be active and current. LPA observed the facility to have adequate food supply. LPA observed fire extinguisher to be serviced on July 19, 2023. LPA observed medications and toxins to be locked and secured. LPA observed daily temperature logs on refrigerator in the kitchen. LPA observed facility to have emergency food supplies to be stocked with expiration date noted on the tubs. Facility was observed to be clean and free of hazards.

Administrator reported to LPA there is no concern at the facility at this time.

Today's inspection, no deficiencies observed. Inspection tool completed and facility is found to be compliance with California Code regulation, Title 22.

Exit interview and a copy of the report was provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2024
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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