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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701040
Report Date: 04/23/2024
Date Signed: 04/23/2024 03:43:58 PM


Document Has Been Signed on 04/23/2024 03:43 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:BRUCEVILLE POINTFACILITY NUMBER:
342701040
ADMINISTRATOR:HOSTETTER, ERICFACILITY TYPE:
740
ADDRESS:9730 BACKER RANCH ROADTELEPHONE:
(916) 226-5300
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:200CENSUS: 138DATE:
04/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:Eric HostetterTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a case management - incident visit. LPA Valerio met with front desk staff, and explained the purpose of the visit. LPA then met with Administrator Eric Hostetter.

LPA Valerio and Administrator Eric discussed five (5) incident reports that were sent by the facility. Incidents included a few falls and an incident between two residents. Administrator Eric discussed the follow up care that has been provided to the residents and an update for each incident. LPA Valerio reviewed Unusual Incident Reports and supportive facility documentation. There were no health, safety, or personal rights violations noted.

An exit interview was held, and a copy of this report was provided to Administrator E. Hostetter.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2024
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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