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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701159
Report Date: 04/18/2023
Date Signed: 04/18/2023 01:39:25 PM


Document Has Been Signed on 04/18/2023 01:39 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:BEATRICE SENIOR CAREFACILITY NUMBER:
342701159
ADMINISTRATOR:CLARK, TIMOTHYFACILITY TYPE:
740
ADDRESS:8901 MELODIC CTTELEPHONE:
(916) 270-3961
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 4DATE:
04/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Beatrice ClarkTIME COMPLETED:
12:30 PM
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On 4-18-23 at 9:50am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding accusation of resident rights violation. LPA met with Administrator Beatrice Clark and explained the purpose of the visit. LPA conducted interviews with resident1 (R1) and R2 and Administrator. Based on interviews conducted it was revealed that Administrator engaged in a conversation with a resident on 3-9-23 which was interpreted as intimidation. LPA discussed resident rights with Administrator

An exit interview was conducted with Beatrice Clark and a copy of this report was provided to Administrator.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2023
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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