<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700201
Report Date: 11/06/2020
Date Signed: 11/06/2020 10:35:49 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:LOVE AND SERENITY OF ELK GROVE IIFACILITY NUMBER:
342700201
ADMINISTRATOR:BIANCA CASTROFACILITY TYPE:
740
ADDRESS:9279 ORANGE CREST COURTTELEPHONE:
(916) 897-9287
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: DATE:
11/06/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Bianca CastroTIME COMPLETED:
10:40 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Suong Teh contacted the facility on this day via telephone to conduct a Case Management. This visit was conducted by telephone in lieu of a physical visit due to the current COVID-19 precautions. LPA spoke with the facility administrator Bianca Castro and explained the purpose of the visit.

During the course of complaint visit conducted on 08/22/2019 the facility was cited section 87411(a) Personnel Requirements.

Facility's failure to adhere to the regulations lack of care and supervision poses an immediate health and safety risk to resident in care.

During today’s facility televisit on 11/06/2020, the facility has been advised that under H&S Code §1569.49 the issuance of a Civil Penalty is currently under review and may be assessed at a later date, due to neglect/and lack of supervision of resident while in the care of the facility.

A copy of this report has been emailed to the facility and the administrator was advised that a signed copy of this report shall be emailed to LPA.

SUPERVISOR'S NAME: Krystall MooreTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6803
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1