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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701327
Report Date: 02/03/2025
Date Signed: 02/04/2025 07:49:56 AM

Document Has Been Signed on 02/04/2025 07:49 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/
DIRECTOR:		RAMIRO, LEILANIFACILITY TYPE:
735
ADDRESS:3300 GREENGATE DRTELEPHONE:
(209) 623-7844
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 4CENSUS: 3DATE:
02/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Leilani Ramiro TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 02/03/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an Annual visit. LPA met with Facility Designated Administrator (FDA), Leilani Ramiro and explained the purpose of the visit. The purpose of this visit was to conduct an Annual visit.
There were 3 other staff members present during the course of this annual visit.

Current census was 3. All residents were out of the facility at this time.
This facility is licensed to serve and retain 4 ambulatory residents. This facility is also vendorized by Valley Mountain Regional Center to serve and retain Level 4I residents at this time.
A brief interview with FDA Ramiro was conducted.

LPA reviewed 3 resident files and 3 staff files. All of which were complete and up to date. LPA reviewed facility emergency drill log. The last drill was conducted on 1/22/2025 with staff and residents. The facility designated administrator has a current administrator certificate #6039601735 and expires on 10/16/2025.

A tour of the facility was conducted.
The fire extinguishers, located throughout the facility was serviced by the Local Extinguisher company, Assured on 01/22/2025. 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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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: 02/03/2025
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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. Emergency supply was present.
A tour of the laundry room was conducted. Washer and dryer were identified. Laundry detergent and other supplies were locked and made inaccessible.
Garage area was toured.
A medication cabinet was located in the kitchen. Along with FDA Ramiro, LPA observed, reviewed and compared medication to medication dispensing logs.
First aid kit was observed to be present and contained all of the required components at this time.

Exterior grounds of this facility was toured.


Perimeter fence and gates were observed to be functional on both sides of the facility. Gates were in good repair at this time with no hazards present. This facility has a large storage unit in the backyard.

The following forms were requested to be submitted to the department:
-LIC 308
-LIC 400
-LIC 500
-LIC 610e

Based on the observations made during this visit no deficiencies are being cited. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025
LIC809 (FAS) - (06/04)
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