<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701235
Report Date: 12/26/2023
Date Signed: 12/26/2023 03:17:17 PM

Document Has Been Signed on 12/26/2023 03:17 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NELLIE'S ANGELS-NORRISFACILITY NUMBER:
342701235
ADMINISTRATOR:JOHNSON, MARNELLI PFACILITY TYPE:
740
ADDRESS:3915 NORRIS AVETELEPHONE:
(916) 436-4036
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 6CENSUS: 3DATE:
12/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:49 PM
MET WITH:Alicia GrayTIME COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Jamie Ivey Canady made an unannounced visit to this facility to conduct an annual required inspection on 12/26/2023. LPA met with caregiver Alicia Gray and explained the purpose for today's visit. Alicia contacted Administrator Marnelli Rechberger who gave Alicia permission to sign for today's visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area and outside courtyard of the facility to ensure compliance with Title 22 regulations.

LPA toured the facility with Alicia on 12/26/2023.

Administrator holds current certificate which expires on 8/14/2024 assigned to Marnelli P Rechberger Cert # 6041793740. The facility is licensed for 6 ambulatory residents. There are currently 3 residents who reside at this facility. There are no residents on hospice.

The facility has an infection control plan in place. The facility has one main screening entry point, and furniture is spaced 6 feet apart. The facility smoke and carbon detectors are in good repair. The facility fire extinguisher is in good repair. The facility has an adequate food supply and has emergency food and water kit. The facility has a first aid kit. Water temperature is 108 degrees. Facility temperature is 75 degrees. The facility has a locked medication cabinet, and the facility has an updated Centrally Stored Medication and Destruction record for each resident in each resident file. 3 resident and 2 staff files have all required documents. The facility also has the required postings through out the facility. The facility is clean and sanitary. The exterior emergency exits are clear of debris.


Per California Code of Regulations (CCRs) - Title 22, no deficiencies cited. Exit interview was held and a copy of report given.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Jamie Ivey-Canady
LICENSING EVALUATOR SIGNATURE: DATE: 12/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1