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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920229
Report Date: 01/14/2025
Date Signed: 01/14/2025 02:32:26 PM

Document Has Been Signed on 01/14/2025 02:32 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:ANGEL TOUCH MEMORY CARE LLCFACILITY NUMBER:
345920229
ADMINISTRATOR/
DIRECTOR:		ANDREASYAN, CHRISTINAFACILITY TYPE:
740
ADDRESS:7765 COTTINGHAM WAYTELEPHONE:
(916) 796-3621
CITY:CIRTUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 0DATE:
01/14/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Christina Andreasyan, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived announced for a scheduled pre-licensing inspection and met with Christina Andreasyan, Administrator. There is a pending RCFE license for (6) residents- (1) resident may be bedridden, and (5) may be non-ambulatory. There are currently no residents present as this location is not currently licensed.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedroom, (2.5) resident bathrooms, staff room, kitchen, laundry and garage. LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting throughout. The bathrooms have the necessary grab bars, non-skid flooring, soap, paper towels. Administrator to post a 20-second hand-washing poster at each sink. LPA observed 7+ day non-perishable food, and sufficient dishes, flatware and cooking pans in the kitchen. Sharps will be locked in the kitchen. There is a medications cabinet with a lock in the kitchen. All toxins will be locked in the laundry room. Hot water measured 115*F in the kitchen and the inside temperature measured 71*F. Fire extinguishers were last serviced on 11/22/24, and the smoke/monoxide alarms are in working order. There is a complete First Aid kit, paper supplies, and sufficient linens/towels/blankets. There are flashlights and night lights on hand. All resident rooms are completely furnished. There are various required postings posted, including the Theft & Loss Policy. There is one exit gate in the backyard, and a table/chairs will be delivered tomorrow. LPA observed folders to be used for staff and resident files to contain the required forms.

During today's inspection, the following items were ordered and will be delivered as early as tomorrow, or by Friday, 1/17/25.
  • Exit door alarms for all exit doors and magnetic lock for the kitchen sharps.
  • PPE supplies, additional games/activities and resident call button necklaces were ordered.
  • Thermometer for the First Aid Kit, phone land lines/internet scheduled to be installed
cont on 809C-1..
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ANGEL TOUCH MEMORY CARE LLC
FACILITY NUMBER: 345920229
VISIT DATE: 01/14/2025
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809C-1... Administrator to add a visitor sign-in area.

Component III was reviewed during today’s inspection.

Pre-Licensing is incomplete with deficiencies to be resolved by 1/17/25.

Administrator to send photos of the door alarms and kitchen drawer lock once they are installed. LPA will inform Centralized Applications Bureau as soon as deficiencies are resolved.

Exit interview. Copy of report left at facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
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