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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340308207
Report Date: 07/27/2021
Date Signed: 07/27/2021 12:17:28 PM

Document Has Been Signed on 07/27/2021 12:17 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:SACRAMENTO GUEST HOMEFACILITY NUMBER:
340308207
ADMINISTRATOR:MANGABAT, NORMINIOFACILITY TYPE:
740
ADDRESS:2715 G ST.TELEPHONE:
(916) 447-1502
CITY:SACRAMENTOSTATE: CAZIP CODE:
95816
CAPACITY: 13CENSUS: 11DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Glayds MagabatTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 07/27/2021 at 11:15 AM. LPA met with Norman Magabat and stated the purpose of today’s visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate # 6019309740 and expires on 08/13/2022. The facility is licensed for fourteen ambulatory resident . There are currently 11 residents who reside at this facility. The facility has hand sanitizer throughout the facility.

The LPA toured the facility with the Gladys Magabat on 07/21/2019 at 11:20 AM.

The facility has submitted an LIC 808 mitigation plan, and it was approved. The facility has a designated area for visits. The facility has covid-19 postings throughout the facility. The facility has one central screening entry point. The facility common areas, bathrooms, and resident rooms are sanitary and furnished. The facility fire extinguishers and smoke detectors are in good repair. The facility has an adequate food supply. The facility has a public phone. The exterior of the facility is sanitary and clear of debris.

There were no deficiencies observed or cited at this annual inspection visit. An exit interview was conducted, and a copy of this 808 report was given to Gladys Magabat.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2021
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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