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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700407
Report Date: 11/21/2023
Date Signed: 11/21/2023 03:14:57 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/21/2023 03:14 PM - 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:A & R QUALITY CARE 2FACILITY NUMBER:
342700407
ADMINISTRATOR:HERNANDEZ, AMORFACILITY TYPE:
735
ADDRESS:5041 JURGENSON WAYTELEPHONE:
(916) 896-5588
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 4CENSUS: 4DATE:
11/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Amor HernandezTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required visit. LPA was met by facility staff, which contacted the administrator to come to the facility. LPA was later met by Administrator Amor, and explained the purpose of the visit.

Due to technological errors, LPA was unable to chose Annual Required Visit as Type of Visit. Although the report says "Case Management - Annual Continuation", this report will suffice for the annual required inspection.

LPA observed the facility practicing infection control procedures upon entry. The facility appeared to be in a clean, odorless, organized, and maintained condition. Upon arrival, there were 2 staff members and 1 resident in care. The other 3 residents were at day program and arrived during the visit. LPA spoke to staff and residents during the visit. LPA and Amor Hernandez toured the facility to ensure compliance with Title 22 regulations. LPA observed 4 resident bedrooms. LPA observed bedrooms to have necessary furniture, to be clean, and free from debris. Resident bathrooms was observed to be clean and free from odors. Common areas were fully furnished. Sharps, medications, and toxins were observed to be locked and inaccessible to residents in care. Staff were observed to be cleaning, assisting residents with snacks, and encouraging residents to participate in activities. The facility had a minimum of 2 days of perishable food items, 7 days of non-perishable food items, and an emergency supply of food and water. The facility fire extinguisher, carbon dioxide detectors, heating/central air was observed to be in working condition.

LPA reviewed facility documentation, staff files, and resident files. Staff files were completed and had required 2023 training. Resident files had necessary files and observed to be complete with up to date information. No health or safety concerns. LPA requested the following be sent to the RO: LIC 500, LIC 308, Liability Insurance, and Surety Bond

Per California Code of Regulations (CCR), no deficiencies were observed. An exit interview was conducted, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2023
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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