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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700735
Report Date: 07/01/2022
Date Signed: 07/01/2022 02:07:21 PM


Document Has Been Signed on 07/01/2022 02:07 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:PALM VALLEY CARE IFACILITY NUMBER:
342700735
ADMINISTRATOR:ANGELITA DAYOANFACILITY TYPE:
740
ADDRESS:8700 MILO COURTTELEPHONE:
(916) 686-2128
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 5DATE:
07/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Angelita DayoanTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility unannounced to conduct a annual/required inspection. LPA Lund met with Administrator Angelita Dayoan and explained the reason for the visit.

LPA Lund & Administrator Angelita Dayoan toured the physical and exterior plant was toured inside and outside to ensure the safety of the residents and compliance with Title 22 regulations. LPA observed the facility to have a first aid kit. The facility is able to designate and dedicated a Covid-19 bedroom and bathroom if needed.

The exterior has fence surrounding a pool that was observed to be locked. LPA Valerio observed the temperature inside the facility was measured at 75*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 facility has 7- day nonperishable and 2- day fresh perishable foods. The centrally stored medications area to be locked and inaccessible to clients. LPA observed fire extinguisher(s) with last check on 05/20/22, smoke and carbon monoxide detectors, central heating and air in the facility.

Per the California Code of Regulations, Title 22, Division 6, no deficiencies observed or cited. Exit interview held, copy of report given to Administrator Angelita Dayoan.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2022
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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