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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700935
Report Date: 02/29/2024
Date Signed: 02/29/2024 04:13:07 PM


Document Has Been Signed on 02/29/2024 04:13 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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:
02/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Care giver Shannon Mcgurk TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) arrived unannounced to conduct annual/required visit. LPA Lund met with Care giver Shannon Mcgurk and explained the reason for the visit. LPA Lund spoke with Administrator Ricky Nolasco who cod not make it today visit. Administrator Ricky Nolasco stated that staff could sign required paperwork. Census: 5
LPA Lund & Care giver Shannon Mcgurk toured/inspected the facility kitchen area was toured. Drawers and cabinets were reviewed. Cook ware, dinnerware, and utensils were observed to be sufficient and able to meet the needs of the residents at this time. Food supply was reviewed for 2-day perishable and 7-day nonperishable food quantities.
Medication cabinet, located in kitchen area, was reviewed. A sample of the resident medications was compared with the facility Medication Administration Record and dispensing log initialed by the facility staff. First aid kit was reviewed for required components and observed to contain all necessary components at this time. Fire extinguisher, located under the kitchen sink, was observed to have been annually purchased and observed to be in compliance at this time. Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in good repair at this time. Facility resident rooms was conducted. Resident bedroom furniture and furnishings were observed to be sufficient. Facility resident restrooms was conducted. Hot water temperatures was taken and measured within the allowed range of 105-120 degrees. Grab bars were observed to be present and functional at this time. Laundry area was toured. Detergents, bleach, and other cleaning agents were observed to be stored and maintained in a separate closet which was locked. Linen closet was observed to contain a sufficient amount of linens and towels. Garage area was toured. A tour of the exterior grounds was conducted. Two Staff & Two Residents files were reviewed and in compliance.
No deficiencies observed or cited during today's annual visit. Exit Interview
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
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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