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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700630
Report Date: 08/28/2023
Date Signed: 08/28/2023 10:29:24 AM

Document Has Been Signed on 08/28/2023 10:29 AM - 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: 3DATE:
08/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Leonil NunezTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required visit. LPA met with facility staff Avery Mata, and explained the purpose of the visit. LPA was later met by Licensee Leonil Nunez and Administrator Lionel Nunez.

LPA and Licensee Leonil toured the facility to ensure compliance with Title 22 regulations. LPA observed 4 resident bedrooms, bathrooms, living room area, dinning area, kitchen, and backyard. Resident bedrooms were fully furnished, organized, and free from debris. Resident bathrooms were fully stocked with soap, paper towels, trash can, hand sanitizer, and hand rails. Hot water was measured at 117.3*F degrees and room temperature was measured at 74* degrees F. Common areas were clean, organized, and free from debris. No emergency exits were obstructed. Medications, cleaning supplies, and sharps were observed to be locked away and inaccessible to residents in care. The facility had a food supply to meet Title 22 requirements. An emergency supply of food and water were observed. PPE supplies were fully stocked. LPA observed the fire extinguisher to be fully charged with last inspection on 07/31/23. Facility staff were observed cleaning the bathroom, assisting a resident with laundry, and engaging with the residents. Residents were observed leaving for Day Program, playing games in their room, and sitting outside on the porch.

LPA reviewed staff and resident files. LPA observed 7 staff files. Staff files had up to date documents and training. Resides files were observed to be current with up to date documents.

LPA requested the following annual documentation be sent to LPA by 09/01/23: LIC 500, LIC 308, LIC 610D

Per California Code of Regulations (CCR) - Title 22, Division 6, no deficiencies were observed during today's visit. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023
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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