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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701319
Report Date: 11/28/2023
Date Signed: 11/28/2023 12:20:22 PM


Document Has Been Signed on 11/28/2023 12:20 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:ALROSE ASSISTED LIVINGFACILITY NUMBER:
342701319
ADMINISTRATOR:LOPEZ, ALBERT ALLAN U.FACILITY TYPE:
740
ADDRESS:7019 MCGILL COURTTELEPHONE:
(916) 718-8189
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:6CENSUS: 3DATE:
11/28/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Albert Allan LopezTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a prelicensing inspection. LPA Moleski met with facility administrator Albert Allan Lopez and explained the purpose of the visit.

LPA Moleski reviewed three resident files (R1-R3).

LPA Moleski toured the facility with Lopez and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 74 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 115 degrees Fahrenheit, which is within the required range of 105 and 120 degrees.

LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and working carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locked closet for the storage of medication. LPA Moleski observed locked cabinets for the storage of cleaning solutions and knives.

LPA Moleski reviewed facility application documents. LPA Moleski completed Component III with Lopez.

LPA Moleski has no objections to licensure. An exit interview was conducted and a copy of this report was left with Lopez.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2023
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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