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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700935
Report Date: 04/09/2026
Date Signed: 04/09/2026 11:17:05 AM

Document Has Been Signed on 04/09/2026 11:17 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:BEATITUDES CARE HOMEFACILITY NUMBER:
392700935
ADMINISTRATOR/
DIRECTOR:		NOLASCO, RICKY C.FACILITY TYPE:
740
ADDRESS:1639 UNITED ST.TELEPHONE:
(209) 647-9701
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 6CENSUS: 6DATE:
04/09/2026
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Ricky Nolasco TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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Unannounced Plan of Correction visit made out to this facility on 04/09/2026 by Licensing Program Analyst (LPA) Arielle Pascua. This LPA was met by the facility staff person Mona Liza Hallman. A brief interview was conducted with the facility staff person at this time. There was on staff member present but left during the course of this visit, Shannon McGurk.
This LPA requested that she go ahead and contact the facility designated Administrator to inform them that CCL was present at this time.
Current census was 6 residents.
The purpose of this visit was to follow up an annual visit conducted on 02/23/2026 and Two Type A violations discussed during the visit.

On 02/24/2026, LPA Pascua received an email from the licensee stating that medication retraining, as outlined in the plan of correction (POC), had been conducted. The licensee also indicated that copies of the February 2026 Medication Administration Record (MAR) were not available at the time of the LPA’s visit.

Additionally, LPA Pascua did not receive documentation of the agreed-upon medication training at the time of the visit with Licensee Nolasco. LPA Pascua subsequently requested, via email, the POC documentation and proof that the training was conducted on 02/24/2026. In response, Licensee Nolasco provided documentation showing two staff members’ signatures and the training date. However, this did not fulfill the agreed-upon POC requirements. The POC specified that the training must be at least one hour in duration and include supporting materials such as training topics, instructional content, and certificates. These documents were not provided to LPA Pascua by the POC due date. In addition, during this visit, LPA Pascua received the MAR for March 2026 and April 2026, however records reveal that documentation has not been completed to its entirety.

NAME OF LICENSING PROGRAM MANAGER: Lisa Rios
NAME OF LICENSING PROGRAM ANALYST: Arielle Pascua
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: BEATITUDES CARE HOME
FACILITY NUMBER: 392700935
VISIT DATE: 04/09/2026
NARRATIVE
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Furthermore, LPA Pascua received an LIC 200 form and a facility sketch from Licensee Nolasco indicating that the garage would remain a garage and not be used as a living space. The licensee also stated that staff were removed from the garage area on 02/24/2026. However, during the visit, LPA Pascua toured the facility and LPA Pascua observed personal belongings in the garage, including clothing, toys, and hygiene items, suggesting that staff may still be occupying and residing in the garage.

Based on the observations made during this visit, The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes.

An exit interview was conducted, a copy of this report and appeals rights were provided to the facility at the end of this visit.

NAME OF LICENSING PROGRAM MANAGER: Lisa Rios
NAME OF LICENSING PROGRAM ANALYST: Arielle Pascua
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/09/2026 11:17 AM - It Cannot Be Edited


Created By: Arielle Pascua On 04/09/2026 at 10:51 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BEATITUDES CARE HOME
FACILITY NUMBER: 392700935

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/10/2026
Section Cited
CCR
87202(1)

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(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.

(1) Nonambulatory persons.
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Licensee shall provide LPA Pascua an updated LIC200 and facility sketch highlighting ambulatory,non-ambulatory rooms, and staff bedrooms by POC Date.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above by not ensuring that the facility accepted and retained ambulatory residents only. Based on observed, the licensee did not ensure that a fire clearance was requested to ensure that the garage space was a habitable living space for staff.
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Type A
04/10/2026
Section Cited
CCR87465(c)(3)

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(3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response.

This requirement is not met as evidenced by:
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The Licensee shall provide LPA Pascua an updated Medication Administration Record for all residents. Along with a statement of correction, medication training for all staff responsible in dispensing medication shall be conducted for no less than one (1) hour. Copies of training including topic, material, and certificates shall be provided to the LPA.
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Based on observation, interview and record review, the lceisnee did not comply with the section cited above by not ensuring that the facility maintained the Medication Administration Record (MAR) for 4 out 4 residents. This poses an immediate health, safety, and personal rights risks to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Rios
NAME OF LICENSING PROGRAM MANAGER:
Arielle Pascua
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2026


LIC809 (FAS) - (06/04)
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