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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700990
Report Date: 02/20/2025
Date Signed: 02/20/2025 11:52:49 AM

Document Has Been Signed on 02/20/2025 11:52 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:VENEMAN CARE HOMEFACILITY NUMBER:
502700990
ADMINISTRATOR/
DIRECTOR:		RAMIT, LOLITAFACILITY TYPE:
740
ADDRESS:3605 NORTHAMPTON LANETELEPHONE:
(209) 623-7844
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 6CENSUS: 5DATE:
02/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Lolita Ramit, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Renee Campbell arrived at the facility to conduct an unannounced annual inspection on 02/20/2025.  LPA met with Lolita Ramit, Administrator (#7015195740) and explained the purpose of the visit. Upon entry LPA Campbell observed one resident in a wheelchair watching TV. A See Something Say Something and Ombudsman posters were displayed in the seating area near the kitchen.

LPA Campbell inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. This facility is a single story building licensed to serve four (4) non-ambulatory residents, two (2) bedridden with a hospice waiver for three (3). Referrals are usually received from Transitions for Life. LPA Campbell observed the facility to be free of odor, clean and in good repair. LPA Campbell observed bedrooms to be properly furnished with appropriate bedding and lighting. There is a pool that LPA Campbell observed surrounded by a gate that is locked.

LPA Campbell observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured in the kitchen at 107 degrees Fahrenheit (F). The thermostat was set at 75 degrees F. LPA Campbell observed that the facility floor plan had not changed. The smoke alarm and carbon monoxide alarm were tested and found to be functioning. The fire extinguisher was last tested on January 10, 2025 and was fully charged. Medication was observed to be inaccessible to clients. The first aid kit was complete and contained scissors, tweezers and a first aid manual along with bandages. The thermometer was at the entrance to the facility for use by guests. LPA Campbell requested client and staff files for review.

LPA Campbell reviewed 4 of 5 resident files and 4 of 7 staff files. All files were observed to be complete. Toxins were made inaccessible to clients in care and were stored in the laundry room.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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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: VENEMAN CARE HOME
FACILITY NUMBER: 502700990
VISIT DATE: 02/20/2025
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The following documents will be sent to LPA Campbell (Renee.Campbell@dss.ca.gov) by 02/28/2025 by 5:00 PM by end of day:
(1) LIC 308 Designation of Administrative Responsibility
(2) LIC 500 Personnel Report

Per California Code of Regulations, Title 22, no deficiencies were observed during today’s visit. A copy of this report was provided to the facility
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
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