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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701320
Report Date: 01/02/2025
Date Signed: 01/02/2025 02:27:12 PM

Document Has Been Signed on 01/02/2025 02:27 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:CASA LORENZOFACILITY NUMBER:
342701320
ADMINISTRATOR/
DIRECTOR:		SUN, LEE ABRAHAMFACILITY TYPE:
735
ADDRESS:10149 BRIAN KELLY WAYTELEPHONE:
(916) 829-5533
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 4CENSUS: 0DATE:
01/02/2025
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Lee Abraham SunTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 05/16/2024, Licensing Program Analyst (LPA) Christina Valerio arrived to conduct a post-licensing visit. LPA Valerio attempted to do a visit but no one was home. LPA Valerio learned there was no residents in care, and therefore, a visit was not conducted. On 01/02/2025, LPA Valerio arrived to complete post-licensing visit.
According to Administrator Lee, there are no residents in care and the facility is waiting to be vendorized by Alta Regional Center.

Per California Code of Regulations (CCR) - Title 22 - no deficiencies were observed during today's visit. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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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