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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700828
Report Date: 01/02/2025
Date Signed: 01/02/2025 01:15:47 PM

Document Has Been Signed on 01/02/2025 01:15 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:LOVE AND SERENITY OF ELK GROVE IIIFACILITY NUMBER:
342700828
ADMINISTRATOR/
DIRECTOR:
CASTRO, BIANCAFACILITY TYPE:
740
ADDRESS:9442 MAZATLAN WAYTELEPHONE:
(916) 585-5483
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 4DATE:
01/02/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Omar Slypher, Staff on dutyTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 1/2/2025, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to this facility to conduct a case management visit. LPA met with Omar Slypher, staff on duty (S1). The administrator, Bianca Castro, was notified of this visit and gave permission to S1 to sign this report. Present during this visit were 4 residents in care with 1 staff on duty (S1).

During a Non-Compliance Conference (NCC) meeting with Bianca Castro, Administrator, on 11/6/2024, regarding another facility under her administration, the Department determined that increased monitoring was required to ensure the facility's compliance. The Department has also determined that licensee is not to admit new residents and to appoint new administrator. Licensee has agreed to these terms.

Per observation, upon LPA's arrival to this facility, one resident was dropped off by a driver (S2) from their appointment. S2 also picked up another resident for another appointment. S2 is currently associated to this facility.

LPA conducted physical inspection of the facility including but not limited to living room, resident bedrooms, bathrooms, kitchen and outdoor area. Room temperature was observed at 72 degrees F. Hot water temperature was taken in one of the bathrooms and was measured at 114 degrees F. Facility maintains 2-day perishable and 7-day non perishable food supplies. Fence and gate were observed to be in good repair at this time.

LPA conducted a record review of one resident (R1) who was admitted prior to the NCC meeting held on 11/6/2024, which include review of admission agreement, medical assessment, and needs and services plan.

According to an interview with Bianca, she has not yet identified a new administrator for this facility at this time as she stated she has having difficulties with recruiting.

No deficiencies are being cited at this time. Exit interview was conducted with S1 and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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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