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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002806
Report Date: 05/23/2023
Date Signed: 05/23/2023 11:46:23 AM


Document Has Been Signed on 05/23/2023 11:46 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: 2DATE:
05/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lovelie ArcegaTIME COMPLETED:
12:00 PM
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On 5/23/2023 LPA Tryon visited the facility to do a Case Management/Health and Safety visit to check on the facility. LPA met with Administrator Lovelie Arcega.

LPA toured the house including common areas, kitchen, resident rooms, bathroom, hallways, storage.
LPA found the home to be nicely furnished and clean.

There are currently 2 residents at the home. Both were in bed when I arrived. LPA spoke with one resident who was awake, she said she was doing okay today.
One resident will be moving out to another facility later today, so only one will remain at this time.

There were 3 staff present when LPA visited.

LPA reviewed food supplies. There appears to be a good supply of both perishable and non-perishable food today. There is more than adequate supply to meet the requirement of 2 days perishable and 7 days non-perishable food.

The home appears to have adequate supplies of other items such as cleaners, sanitary supplies, etc.

At this time the residents appear to be doing fine, there is plenty of staff to meet their needs and a good supply of food and supplies.

Exit interview conducted.


SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023
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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