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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700935
Report Date: 03/02/2023
Date Signed: 03/07/2023 10:32:28 AM

Document Has Been Signed on 03/07/2023 10:32 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:BEATITUDES CARE HOMEFACILITY NUMBER:
392700935
ADMINISTRATOR:NOLASCO, RICKY C.FACILITY TYPE:
740
ADDRESS:1639 UNITED ST.TELEPHONE:
(209) 647-9701
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 6CENSUS: 5DATE:
03/02/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ricky NolascoTIME COMPLETED:
11:00 AM
NARRATIVE
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Unannounced post licensing visit made out to this facility on 03/02/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver Harveen Sidhu. This LPA requested that she go ahead and contact the facility designated Administrator to inform him that CCL was present at this time. The facility designated Administrator, Ricky Nolasco, was present and was briefly interviewed by this LPA at this time. Administrator certificate was reviewed for Ricky Nolasco and observed to have expired on 09/28/2022.
The facility designated Administrator stated that he was currently showing to be "Pending" and all documents and forms, including paid fee, have been submitted at this time.
Current census was 5 residents of which there weren't any residents under the care of hospice and no residents were under the care of home health. This facility does have an approved hospice waiver to accept and retain up to (3) hospice residents.
Tour of the facility was conducted.

Visit was conducted in collaboration with the annual visit as well.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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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