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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003565
Report Date: 06/14/2022
Date Signed: 06/14/2022 04:34:45 PM

Document Has Been Signed on 06/14/2022 04:34 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ALEGRE LOVELACE CARE HOMEFACILITY NUMBER:
347003565
ADMINISTRATOR:LOVELACE, DENISEFACILITY TYPE:
735
ADDRESS:10320 CANADEO CIRTELEPHONE:
(916) 585-9591
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 6CENSUS: 4DATE:
06/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Edilberto AraujoTIME COMPLETED:
04:45 PM
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On 6/14/2022 at 3:30 PM, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit. Prior to entering the facility, LPA Truong attempted to contact the facility. Upon LPAs arrival, Caregiver Edilberto Araujo was present at facility and contacted Administrator Denise Lovelace. Administrator informed LPA she is unable to come to the facility. LPA was advised that Ediberto Araujo can assist LPA with today’s visit.

Administrator holds current certification #6008428735 and expires on 12/7/2023. The facility is licensed to serve 6 developmental adults. There are currently 4 clients who reside at this facility. LPA toured the facility with Edilberto Araujo on 6/14/2022 at 3:50 PM.

LPA inspected the physical plant including but not limited to the kitchen, dining area, client bedrooms, client bathrooms, laundry room, common area, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. The hot water temperature was observed to be 109.8 degrees Fahrenheit. Facility thermostat observed at 70 degrees Fahrenheit. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed knives and toxins to be locked away and inaccessible to clients. Smoke and carbon detectors were in good repair. Fire extinguisher and first aid kit was up to date. LPA checked medication storage and found medication to be locked away and inaccessible to clients. LPA also conducted the infection control domain tool.

Report continued on 809-C
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: ALEGRE LOVELACE CARE HOME
FACILITY NUMBER: 347003565
VISIT DATE: 06/14/2022
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The facility mitigation plan was submitted to CCLD and approved on 4/28/2021. Facility has routine symptom screening checks for clients, staff, and visitors. The facility has a symptom check binder for staff, clients, and care staff. Hand Hygiene procedures have been implemented. Facility had Covid-19 posters throughout the facility, and the facility has implemented Covid-19 mitigation plan.

LPA requested the following documents for the facility file:
(1) LIC308 Designation of Administrative Responsibility
(2) LIC500 Personnel Report
(3) LIC610 Emergency Disaster Plan
(4) Proof of Current Liability Insurance
(5) Copy of Administrator Certificate

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
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