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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003576
Report Date: 07/29/2022
Date Signed: 07/29/2022 03:19:01 PM

Document Has Been Signed on 07/29/2022 03:19 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:VERGIE RAMOS HOME II, THEFACILITY NUMBER:
347003576
ADMINISTRATOR:RAMOS, VERGIEFACILITY TYPE:
735
ADDRESS:9424 TIMBER RIVER WAYTELEPHONE:
(916) 478-1340
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 5DATE:
07/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator Vergie Ramos.TIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility unannounced to conduct an annual/required inspection. LPA met with Administrator Vergie Ramos and explained the reason for the visit. Census 5.

LPA Lund toured the physical plant and outside to ensure the safety of the residents and compliance with Title 22 regulations. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in the facility. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored toxins are kept locked and inaccessible to clients.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held with facility staff and copy of report was left for Administrator Vergie Ramos.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2022
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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