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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700630
Report Date: 07/14/2021
Date Signed: 07/14/2021 12:04:06 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: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: 1DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Stanley VillanuevaTIME COMPLETED:
11:30 AM
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On 07/14/21 at 10:41 AM, Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual inspection. LPA met with facility Stanley Villanueva stated the purpose of today’s visit. LPA Valerio was screened for COVID-19 symptoms and temperature taken prior to being allowed entry into the facility that is licensed to serve a total capacity of 4 clients.
 
The physical plant was toured inside and outside to ensure the safety of the residents and compliance with Title 22 regulations. LPA also conducted the infection control domain tool. The facility has an approved LIC 808 mitigation plan on file. LPA observed the facility to have a first aid kit, hand washing signage, and COVID - 19 informational signage posted at the front door and throughout the facility. The facility is able to designate and dedicated a Covid-19 bedroom and bathroom. Common touch surfaces are cleaned after each use.
 
LPA observed the temperature inside the facility was measured at 68.9 *F, which is within the required range of 68 degrees F (20 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat the maximum shall be 30 degrees F (16.6 degrees C) less than the outside temperature. The hot water was measured at 114.5 *F, which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C) as per Title 22 regulations. 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 a pull alarm system, fire extinguisher(s) with last check on 08/16/2020, smoke and carbon monoxide detectors, central heating and air in the facility.
 
Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. LPA Valerio spoke to Administrator Lionel over the phone to discuss today's visit. Exit interview held with staff Stanley and a copy of report was left for Administrator Lionel Nunez.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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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