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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701235
Report Date: 02/10/2025
Date Signed: 02/10/2025 11:25:27 AM

Document Has Been Signed on 02/10/2025 11:25 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:NELLIE'S ANGELS-NORRISFACILITY NUMBER:
342701235
ADMINISTRATOR/
DIRECTOR:		JOHNSON, MARNELLI PFACILITY TYPE:
740
ADDRESS:3915 NORRIS AVETELEPHONE:
(916) 436-4036
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 6CENSUS: 4DATE:
02/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Stephanie ReidTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Holly Williams arrived unannounced to conduct an annual inspection. LPA Williams spoke with licensee Nellie Johnson and Johnson gave permission for designee Stephanie Reid to sign the report for Nellie Johnson.

LPA Williams reviewed 4 resident files (R1-R4) and 2 staff files (S1-S2).

LPA Williams toured the facility with Reid and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 78 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 119.6 degrees Fahrenheit, which is within the required range of 105 and 120 degrees.

LPA Williams observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and working carbon monoxide/smoke detectors. LPA Williams observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Williams observed a locked cabinet for the storage of medication. LPA Williams observed locked cabinets for the storage of cleaning solutions and knives.

LPA Williams interviewed 2 staff member (S1-S2) and 1 residents (R1).

No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Stephanie Reid.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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