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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804108
Report Date: 12/03/2024
Date Signed: 12/03/2024 10:26:27 AM

Document Has Been Signed on 12/03/2024 10:26 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ANGEL'S PLACE IN MOSSWOOD PLACEFACILITY NUMBER:
496804108
ADMINISTRATOR/
DIRECTOR:
DICHOSO, ALMAFACILITY TYPE:
740
ADDRESS:311 MOSSWOOD LANETELEPHONE:
(707) 708-2694
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 6CENSUS: 2DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Alma Dichoso (Licensee)TIME VISIT/
INSPECTION COMPLETED:
10:36 AM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and met with Licensee, Alma Dichoso. Annual fees are current. Contact information was reviewed.

LPA/Licensee initiated a tour of the facility at 9:00 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Water temperature in resident's bathroom was 111.4 degrees F which is within the allowable range of 105 to 120 degrees F per regulation. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Cabinets containing cleaning supplies are located in the garage and were locked. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked.

Fire extinguisher was last inspected January, 2024. Smoke detectors located throughout the facility were tested and operational. Carbon monoxide detector was tested and operational. Exit doors have auditory alert system and were functional at time of visit. Last disaster drill conducted on October 2024.

File review initiated at 9:30am of two staff files and two resident files. Staff have required training records, First Aid and CPR certificates. Two resident's files have current medical assessment and care plans. Administrator Certificate for Licensee, Alma Dichoso #7028288740 expires 06/02/2026. Medications and medication records were reviewed. Required postings were observed.

Licensee agreed to submit updates of the following documents by not later than 12/10/24: Personnel Report (LIC500), Designation of facility responsibility (LIC308), lease agreement and Emergency Disaster Plan (LIC610E if there are any changes).

No deficiencies cited during this inspection. Exit interview conducted with Licensee and copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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