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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345003006
Report Date: 08/08/2024
Date Signed: 08/08/2024 12:00:34 PM

Document Has Been Signed on 08/08/2024 12:00 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:FOUR ANGELS CARE HOMEFACILITY NUMBER:
345003006
ADMINISTRATOR/
DIRECTOR:		MAMARIL, THELMAFACILITY TYPE:
735
ADDRESS:5616 RIDGEPOINT DR.TELEPHONE:
(408) 477-0978
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 4CENSUS: 0DATE:
08/08/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Thelma Mamaril and Nino DomalantaTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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On 08/08/24, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility announced to conduct a Required-1 Year Inspection. LPA met with Administrator, Thelma Mamaril and Nino Domalanta, to conduct the visit. There are currently no residents at the facility. Administrator stated that they are vendorized as of 08/01/24 by Alta California Regional Center (ACRC).

LPA and administrator toured the interior and exterior of the facility. Areas toured include but are not limited to: four (4) residents' bedrooms, two (2) bathrooms, kitchen, common areas, garage and backyard. LPA observed required furniture, and lighting throughout the residents' bedrooms and facility. LPA observed residents' bathrooms to be clean, sanitary, and in good repair. The hot water temperature was measured in the kitchen at 118.1 degrees Fahrenheit which is within the required range of 105 to 120 degrees Fahrenheit. Facility has locked areas for toxins, cleaning solutions, knives and medications. LPA observed fire detectors and carbon monoxide alarms to be operable. The fire extinguisher was last serviced on 05/24/24. LPA observed required Licensing posters posted throughout the facility. First aid kit was completed.

No deficiencies being cited during today's inspection.

Exit interview conducted and report provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2024
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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