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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700201
Report Date: 04/28/2021
Date Signed: 04/28/2021 04:37:14 PM

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: 5DATE:
04/28/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Bianca CastroTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Victoria Brown Licensing Program Analyst (LPA) Victoria Brown contacted the facility via telephone to commence an unannounced Tele-visit on 4/28/21 at 4:15pm due to COVID-19 and pre-cautionary measures.

LPA met with Bianca Castro and stated the purpose of the visit which is to ensure the instructions provided in the Health and Safety Code Section 1569.38 are being followed according to the accusation. The instructions include, but not limited to, 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. The accusation was served on 4/7/21.

Licensee was previously 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. LPA has received a copy of the notifications and observed the posting of the accusation, and the (LTCO) was called and letter was sent.

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 facetime 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: 04/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021
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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