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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701275
Report Date: 01/05/2024
Date Signed: 01/08/2024 11:15:31 AM

Document Has Been Signed on 01/08/2024 11:15 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 HOME IFACILITY NUMBER:
392701275
ADMINISTRATOR:NOLASCO, RICKY C.FACILITY TYPE:
740
ADDRESS:925 CLEARWATER CREEK BLVDTELEPHONE:
(209) 647-9701
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY: 6CENSUS: 4DATE:
01/05/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Ricky NolascoTIME COMPLETED:
12:00 PM
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Unannounced Plan of Correction visit made out to this facility on 01/05/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Ricky Nolasco. A brief interview was conducted with the facility designated Administrator at this time.
Current census was 4 residents.
The purpose of this visit was to review and make sure that the following deficiencies that were previously cited on 12/13/2023 were corrected according to the plan of correction:
  1. Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).
  2. The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR.
The clearance letter was printed and a copy was given to the facility designated Administrator at this time.

There were no further deficiencies observed or cited at this time.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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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