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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701275
Report Date: 06/23/2023
Date Signed: 08/07/2023 01:33:09 PM

Document Has Been Signed on 08/07/2023 01:33 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:BEATITUDES CARE HOMEFACILITY NUMBER:
392701275
ADMINISTRATOR:NOLASCO, RICKY C.FACILITY TYPE:
740
ADDRESS:925 CLEARWATER CREEK BLVDTELEPHONE:
(209) 647-9701
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY: 6CENSUS: 0DATE:
06/23/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ricky NolascoTIME COMPLETED:
12:00 PM
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On June 23rd at 9:30am Licensing Program Analyst (LPA) Jennifer Fain and Licensing Program Manager (LPM) Liza King arrived at the facility announced to conduct a pre licensing visit. LPA and LPM met with Licensee Ricky Nolasco and explained the reason for the visit.

LPA Fain and LPM King toured the grounds and physical plant. The grounds were observed to be clear of debris and all paths were unobstructed. LPA Fain observed patio furniture with shaded areas for residents to enjoy outdoor activities. The physical plant has 4 resident bedrooms and 3 bathrooms that may or may not be for residents' use depending on assistive devices. Master bathroom has a roll in shower for resident bathing. The interior of the facility was observed to be sanitary, adequately furnished and adequately lit. The facility was observed to be kept at 75* F. The facility maintains an adequate supply of linens and hygiene products. The bedrooms contained a night stand, lamp, dresser and chair. The mattresses were observed to have mattress covers. Night lights were observed in the hallways. The facility has locked storage areas for medications, toxins and knives. All appliances appeared to be in good working order. The first aid kit is complete with scissors, tweezers, thermometer, manual and various wound dressings. The Emergency Disaster plan was reviewed and determined to be in compliance. The fire extinguisher was serviced 3/2/2023 and is in compliance. The carbon monoxide detectors and smoke detectors are hard wired and were determined to be in good working order. Water temperature was taken in the kitchen and read at 116.2 degrees. Two screens have small holes which were patched during the visit and will be reinspected at Post Licensing Inspection. The Pre-Licensing Inspection Tool was utilized during the course of this visit.

The facility was determined to be in substantial compliance with the Health and Safety Code and the California Code of Regulations. The facility has passed the pre-licensing inspection. Component III was waived as it was provided on 1/12/21 to Licensee during pre licensing at facility number 392700935, which has no compliance concerns.
An exit interview was conducted and a copy of this report was provided to Licensee
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Jennifer Fain
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2023
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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