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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700630
Report Date: 09/13/2022
Date Signed: 09/13/2022 02:20:49 PM

Document Has Been Signed on 09/13/2022 02:20 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:L.P. NUNEZ CARE FACILITY #3FACILITY NUMBER:
342700630
ADMINISTRATOR:NUNEZ, LIONELFACILITY TYPE:
735
ADDRESS:8528 BIRCH CREST CTTELEPHONE:
(916) 647-9670
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 4DATE:
09/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:17 PM
MET WITH:Lionel NunezTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct the required annual inspection. LPA Valerio was met by facility staff, and explained the purpose of the visit. Staff confirmed there are 0 residents or staff that have displayed any signs or symptoms of COVID in the last 10 days.

LPA completed the infection control tool. LPA observed necessary signage located at the front door and common area of the facility. LPA and facility staff toured the facility including but not limited to 4 client bedrooms, 2 bathrooms, living room, dining room, kitchen, front yard and back yard. LPA observed the facility to be free of odor, clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed the temperature inside the facility was measured at 72*F.  The hot water was measured at 106.3 *F. Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed the centrally stored medications area and sharps to be locked and inaccessible to clients. LPA Valerio observed fire extinguisher(s) with last check on 08/04/2022. Smoke and carbon monoxide detectors were in good repair. LPA observed 2 staff files that showed CPR and first aid up to date.

LPA requested the following documentation to be sent: LIC 500, Administrator Certificate, LIC 308, LIC 400, Surety Bond, and LIC 610D

Per California Code of Regulations, Title 22, no deficiencies are being cited. An exit interview was held with Administrator Lionel Nunez, and a copy of the report was given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2022
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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