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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002597
Report Date: 06/18/2024
Date Signed: 06/18/2024 12:52:33 PM


Document Has Been Signed on 06/18/2024 12:52 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:ALLEN'S CARE HOME #2FACILITY NUMBER:
347002597
ADMINISTRATOR:ALLEN, MELVINAFACILITY TYPE:
735
ADDRESS:1304 MAIN AVENUETELEPHONE:
(916) 359-4319
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY:6CENSUS: 4DATE:
06/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Melvina AllenTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Tung Truong arrived at the facility unannounced to conduct a quarterly health and safety visit following the Non-Compliance meeting dated 08/04/2023. LPA met with Administrator Melvina Allen and explained the purpose of the visit.

LPA toured and inspected the physical plant inside and outside to ensure there were no health and safety concerns. LPA observed the facility to be clean and free of debris. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The temperature inside was observed at 70 degrees Fahrenheit which is within the required range of 68-85*F. Fire extinguishers and first aid kits were up to date.

LPA requested staff files for review. LPA reviewed (3) staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility.
Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was given to Administrator Melvina Allen.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024
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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