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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701327
Report Date: 01/30/2024
Date Signed: 01/31/2024 08:00:14 AM

Document Has Been Signed on 01/31/2024 08:00 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:RAMI HOMES LLCFACILITY NUMBER:
502701327
ADMINISTRATOR:RAMIRO, LEILANIFACILITY TYPE:
735
ADDRESS:3300 GREENGARE DR.TELEPHONE:
(209) 623-7844
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 4CENSUS: 0DATE:
01/30/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Leilani Ramiro TIME COMPLETED:
12:00 PM
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On 1/30/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA Pascua met with applicant, Leilani Ramiro and explained the purpose of the visit. The purpose of the visit was to conduct a Pre-Licensing visit. There were two other persons at this visit, Gerardo Ramiro and Gardilo Ramit.
This facility intends to hold 4 residents who are deemed to be ambulatory only. This facility intends to be vendorized by Valley Mountain Regional Center to hold level 4I residents at this time.
Current census was 0.
Facility Designated Administrator has a current and active certificate #6039601735 and expires on 10/16/2025.
The fire extinguishers, located throughout the facility was purchased on 1/30/2024. Carbon Monoxide and fire alarms were present and in good repair.
Common areas for resident use were toured. Furniture and furnishings were observed to be present and in compliance.
A tour of the bathrooms was conducted. Hot water temperatures were taken to ensure that the hot water being dispensed was within the allowed range of 105-120 degrees at this time.
Resident bedrooms were toured. Furniture and furnishing were observed to be present and in good condition. A tour of a staff bedroom was also conducted.
A linen closet was located in the hallway. LPA observed a sufficient amount of linens at this time.
The kitchen area was toured. Facility freezer and refrigerator showed to be functional and in compliance at this time. A tour of the pantry was conducted. LPA observed that there was a 7-day nonperishable food supply at this time.
Garage area was toured. Laundry detergent and cleaning supplies were locked and made inaccessible at this time. Washer and dryer were identified.
This facility will be using a medication cabinet which was located in the kitchen.
First aid kit was observed to be present and contained all of the required components at this time.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: RAMI HOMES LLC
FACILITY NUMBER: 502701327
VISIT DATE: 01/30/2024
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Exterior grounds of this facility was toured.
Perimeter fence and gates were observed to be functional and in good repair at this time.
This facility has been observed to be in compliance at this time.

There were no deficiencies observed during the course of this Pre-licensing visit.

Applicant has already conducted Comp I and Comp II.
Comp III was reviewed with applicant.

Exit Interview was conducted and a copy of this report was provided to the applicant at the end of the visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
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