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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003565
Report Date: 05/10/2024
Date Signed: 05/10/2024 02:51:07 PM

Document Has Been Signed on 05/10/2024 02:51 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:ALEGRE LOVELACE CARE HOMEFACILITY NUMBER:
347003565
ADMINISTRATOR/
DIRECTOR:		LOVELACE, DENISEFACILITY TYPE:
735
ADDRESS:10320 CANADEO CIRTELEPHONE:
(209) 353-6037
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 6CENSUS: 3DATE:
05/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:06 PM
MET WITH:Jaden SimpsonTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a case management visit. LPA met with facility staff, and explained the purpose of the visit. Facility staff contacted designated staff Zana Mitchell via cell phone. Designated staff Zana assigned facility staff to sign due to Zana picking up the other resident from Day Program .

LPA Valerio observed 1 staff and 2 residents present in the facility. LPA Valerio informed the facility of a Decision and Order, which became effective May 3rd, 2024, regarding Staff 1 (S1). Facility staff and Licensee was made aware S1 is prohibited from employment in, presence in, and contact with clients of, any facility licensed by the Department, certified or approved by a licensed foster family agency, or any resource family home, and is also prohibited from holding the position of member of the board of directors, executive director, or officer of the licensee of any facility licensed by the Department, for the remainder of R1's life.

LPA Valerio did not observe R1 in the facility during the time of the visit.

LPA observed the facility. LPA observed residents watching television and listening to music on their phone. Staff was observed assisting residents and finishing laundry. LPA did not observed any immediate health, safety, or personal rights risk. No deficiencies are being cited.

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: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2024
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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