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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 02:28:15 PM

Document Has Been Signed on 01/02/2025 02:28 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:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Lee Abraham Sun TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with Administrator Lee Abraham Sun, and explained the purpose of the visit.

LPA Valerio observed zero (0) residents in care. LPA Valerio observed the facility to be clean and free from debris. All resident rooms are move-in ready. Resident bathrooms are operational. LPA Valerio did not observe any health or safety hazards during the visit.

Administrator Lee Abraham Sun stated they are in-process of being vendorized with Alta California Regional Center.

LPA Valerio and Administrator went over annual documentation. Administrator had no further questions.

Per California Code of Regulations (CCR) - Title 22, no deficiencies are being cited today. 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: 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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