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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700201
Report Date: 04/12/2021
Date Signed: 04/12/2021 11:24:09 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:
04/12/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
10:30 AM
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Licensing Program Analyst(s) Victoria Brown and Tirzah Hubbard, Licensing Program Manager Stephenie Doub held an office meeting on 4/12/21 at 10am on a Microsoft Teams Meeting video conferencing system due to Covid-19 and precautionary measure. This visit is to review instructions provided in the Health and Safety Code regarding accusations. The accusation was served on 4/7/21 and a copy was emailed to all parties on 4/8/21. LPA received a text message from Mike Her on 4/9/21 confirming that the accusations were received and will be reviewed.

The following were in attendance: Representatives, Administrators and Licensees of Love and Serenity LLC, Love and Serenity IV, Love and Serenity of Vintage Park, Love and Serenity Elk Grove, Love and Serenity of Elk Grove II, Love and Peace Home Care, Love and Peace II Elderly Care, Javier Castro, Ratu “Pio” Vunimatana, Mike Her, Anthony Camacho, Karalaini Muliaceva, Unaisi Bolatolu, and Julie Nonu. Deborah Saunikalou and Bianca Castro were also invited but was not in attendance.

This meeting is held to confirm receipt of the accusation, review its contents and to review the Health and Safety Code Section 1569.38. Which includes, but not limited to, the instructions regarding the requirement to notify the residents and Local Ombudsman (LTCO) within 10 days and to post a notice in a conspicuous location advising that an action is pending.
Licensee was informed that CCL shall receive copies of the notifications to all residents and/or responsible parties and that civil penalties could be assessed if licensee fails to follow the requirements.

Licensee was also advised to contact the Legal Division with any questions regarding Notice of Defense.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were cited during this visit. An exit interview was held via Teams and a copy of this report was provided via email. An electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021
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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