Facility Evaluation Report

Four Angels Care Home, Antelope09/01/2023Licence 345003006

Capacity4
Census0
Date signed09/05/2023 09:34:58 AM
The inspector’s account

On September 1, 2023 LPA Tryon visited the facility to do a pre-licensing visit. LPA met with applicants Thelma Mamaril and Nino Domalanta.

LPA toured the house including kitchen, living room, visiting room, bedrooms, hallways, bathrooms, garage, laundry area, yard. The facility is clean, nicely furnished and pleasant. The bedrooms have appropriate furniture and plenty of space. The backyard is fenced and has space for activities and shady areas. There is a hot tub in the back yard with a cover, but the applicants plan to dispose of the hot tub as soon as possible. The home will notify CCL as soon as the hot tub is gone.

The home has installed smoke detectors and carbon monoxide detectors, has charged fire extinguisher that was recently checked/serviced.

There is locked storage for medications, knives/potentially hazardous items, etc. The home has plenty of dishes/cups, pots and pans, utensils, kitchen appliances, etc. The home has plenty of food supplies present including 2 days perishable and 7 days non-perishable supplies.

LPA reviewed the CARE Tool for pre-licensing with the applicants.

LPA also reviewed the Adult Residential Orientation Part III with the applicants. Applicants have now completed Orientation Part III.

At this time, the facility appears to be in substantial compliance with regulations. There is a hot tub in the yard, but it has a tight-fitting cover with a LOCK and the applicants plan to dispose of the hot tub.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction