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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002806
Report Date: 04/17/2023
Date Signed: 04/17/2023 10:38:29 AM


Document Has Been Signed on 04/17/2023 10:38 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 NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:SPRINGVIEW ELDERLY CAREHOMEFACILITY NUMBER:
315002806
ADMINISTRATOR:ARCEGA, LOVELIEFACILITY TYPE:
740
ADDRESS:5536 GRAHAM CT.TELEPHONE:
(916) 672-6945
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 3DATE:
04/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Lovelie ArcegaTIME COMPLETED:
10:45 AM
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On 4/17/23, Licensing Program Analyst (LPA), Kevin Mknelly, conducted a case management health and safety visit. LPA met with Administrator and explained the reason for the visit. LPA followed the Department's current Covid-19 precautions and wore a surgical mask while present .
Staff were wearing masks.

LPA did an inspection of the interior and exterior of the home. The home is clean and in good repair. The rear fence needs repair.
Two staff are present and resident needs appear to be met.
LPA obtained resident and staff rosters as well as licensee contact information

The facility has a resident with Covid. LPA discussed precautions and provided a PPE don/doff procedures sign.

As a result of todays inspection there are no deficiencies cited at this time.

Report reviewed with and copy provided
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2023
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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