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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002998
Report Date: 01/29/2025
Date Signed: 01/29/2025 10:46:14 AM

Document Has Been Signed on 01/29/2025 10:46 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WELLCARE HOMES 4 - ENGLE HOMEFACILITY NUMBER:
345002998
ADMINISTRATOR/
DIRECTOR:		QUIROZ, VENETHFACILITY TYPE:
734
ADDRESS:5029 ENGLE RDTELEPHONE:
(916) 230-4087
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 5CENSUS: 5DATE:
01/29/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Administrator- Veneth QuirozTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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On 01/29/2025, Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Cassie Yang arrived unannounced to conduct an annual inspection. LPAs met with Administrator, Veneth Quiroz, and explained the purpose of the visit.

Facility is licensed for five (5) non ambulatory residents, today's census is five (5). LPAs observed facility to be staffed with three (3) direct support professionals, one (1) respiratory therapist, one (1) licensed vocational nurse, and one (1)registered nurse.

LPAs and Administrator conducted a tour of the facility. Areas toured included but not limited to: five (5) resident rooms, shower room, laundry room, bathroom, kitchen and common areas. LPAs observed facility to be at 71*. LPAs observed the facility to have adequate food supply. LPAs observed fire extinguisher to be serviced on May 20, 2024. LPAs observed medications and toxins to be locked and secured. LPAs 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 LPAs 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: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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