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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601099
Report Date: 02/09/2024
Date Signed: 02/09/2024 07:25:30 PM


Document Has Been Signed on 02/09/2024 07:25 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
SAN BRUNO RO, 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: 4DATE:
02/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Andrew Ang & Ivy MecanoTIME COMPLETED:
03:45 PM
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On 2/9/24 LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator Andrew Ang and Lead Staff Ivy Mecano. LPA explained the purpose of the visit..

LPA toured the facility inside and outside including all of resident rooms, and kitchen area. All residents are currently in Adult Day Program. While touring the facility it was observed that the room temperature was at 71 deg F. Hot water was also tested in the bathrooms and the temperature was 112 deg F. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Sharps and toxic materials were observed locked and inaccessible to residents. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Carbon monoxide/ smoke detectors, and fire extinguisher were present throughout the facility. Facility has an updated log for emergency drill is done every quarter.

Four resident records and four staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs. Staff have current First Aid/CPR certifications on file.

Centrally stored medication was locked and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated.

LPA requested the following: LIC 308, Certificate of Liability Insurance, LIC 500.

No deficiencies being cited today. Report is reviewed and copy is provided.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024
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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