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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003611
Report Date: 08/07/2023
Date Signed: 08/07/2023 04:29:58 PM


Document Has Been Signed on 08/07/2023 04:29 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:PRECIOUS ANGELS CAREFACILITY NUMBER:
347003611
ADMINISTRATOR:ALEJO, GLORIAFACILITY TYPE:
740
ADDRESS:8983 RICHBOROUGH WAYTELEPHONE:
(916) 549-2724
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 3DATE:
08/07/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:36 PM
MET WITH:Lulu MiyashiroTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a case management - health and safety visit. LPA met with facility staff, and explained the purpose of the visit.

LPA toured the facility's physical plant to ensure compliance with Title 22 regulations. LPA observed the facility's food supply. The facility has a minimum of 7 days of non-perishables and 2 days of perishable food items. An emergency food and water supply was also observed in the food cabinet. The home was fully stocked with PPE, office supplies, cleaning supplies, and hygiene supplies.

LPA requested information regarding utility bills and/or any charges associated to the operation of the facility. According to the Licensee, all facility bills are paid and are not past due. According to interview with Licensee, food and supply orders come to the facility and there are no issues with getting the items at this time.

Residents were observed eating lunch. Lunch was rice, Filipino longanisa sausage, and vegetables in addition to their drinks.

Per Califonia Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, no health or safety concerns were associated to this visit. An exit interview was held was designated administrator Gloria, a copy of the report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023
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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