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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601099
Report Date: 03/11/2021
Date Signed: 03/11/2021 01:56:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ANGEL'S TOUCH RCFE, LLCFACILITY NUMBER:
415601099
ADMINISTRATOR:ANG, JEHOIAKIM ANDREW C.FACILITY TYPE:
740
ADDRESS:80 ARLINGTON DRIVETELEPHONE:
(510) 265-4545
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:6CENSUS: 0DATE:
03/11/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Andrew AngTIME COMPLETED:
11:35 AM
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On March 11, 2021 at 9:56am Licensing Program Analyst (LPA) Chris Hopkins conducted an announced pre-licensing inspection. LPA met and toured the facility with the Administrator Andrew Ang.

This is a one story facility. There are 3 bedrooms and 1 bathroom. There are no shared rooms, each client will have their own bedroom as of now. Client rooms are furnished with required lighting fixtures and furniture. Clients bathroom was observed and in good repair and water temperature within regulation testing at 112 degrees Fahrenheit. Client linen closet is observed as stocked and in place. Dining room and kitchen observed. LPA observed the canned and dry goods located in the garage along with the washer and dryer. Cleaning supplies stocked and locked in garage cabinet. Backyard is fenced and secured, along with two storage sheds with extra furniture that will be locked. Emergency exits are located in two out of 3 client bedrooms and clear of any obstructions. Medications are locked in a medication cabinet located in the dining room area.

LPA observed one fire extinguisher in the facility, located in the kitchen. Fire Extinguisher last serviced on December, 2020. Smoke and carbon monoxide combination detectors present throughout the facility. First aid kit is in place with required items.

The following posters/forms posted in the Living Room: Emergency Disaster Plan, Emergency Telephone Numbers, Client Personal Rights, Floor Plan, Theft and Loss Policies and Procedures and Licensing Complaint Poster (1-844-LET-US-NO).

Report Continued on LIC809-C
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2021
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ANGEL'S TOUCH RCFE, LLC
FACILITY NUMBER: 415601099
VISIT DATE: 03/11/2021
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Page 2 LIC809-C

Staff do not reside on site. Administrator plans on hiring a NOC shift staff. There will be staff present at the facility 24 hours a day 7 days a week. LPA observed staff files as current. Administrator certificate is observed as current expiring on 9/20/2021. Component III completed after tour of facility.

As a result of inspection today, the facility meets the physical plant requirements of California Code of Regulations, Title 22. Immediate licensure is recommended, pending final approval from the Central Applications Bureau.

No deficiencies cited.

This report was discussed with Andrew Ang and a copy was given to him via email.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2021
LIC809 (FAS) - (06/04)
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