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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701431
Report Date: 09/23/2024
Date Signed: 09/23/2024 11:20:34 AM

Document Has Been Signed on 09/23/2024 11:20 AM - 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:R&E SENIOR CARE 2, INCFACILITY NUMBER:
342701431
ADMINISTRATOR/
DIRECTOR:		PASCUA, EMILY B.FACILITY TYPE:
740
ADDRESS:9351 CAULFIELD DRIVETELEPHONE:
(916) 895-4357
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 6CENSUS: 0DATE:
09/23/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Emily PascuaTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 09/23/24, Licensing Program Analyst (LPAs) Vincent Moleski and Holly Williams arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPAs met with applicants Emily Pascua and Randy Pozon, and the applicant's consultant Theresa Lane and explained the purpose of the visit.

It was learned that this facility will be licensed to serve up to 6 non ambulatory residents. The temperature inside the facility was observed to be at 76*F which is within the required range of 68-85*F. LPAs Moleski and Williams observed knives and toxins to be locked away and inaccessible to clients. Smoke and carbon detectors were in good repair. Fire extinguisher was up to date. LPAs Moleski and Williams observed the centrally stored medication areas to be locked and made inaccessible to prospective residents at this time. LPA observed no obstruction of emergency exits inside or outside of facility.

Based on a review of this facility during this Pre-licensing visit, it was determined that this facility was found to be in compliance at this time. Applicant has completed Component III. LPAs Moleski and Williams will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed.

An exit interview was held and a copy of the report was left with Pascua.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
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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