347003565-2-13-2024-27-AS-CVAO-D2F2GL-20240213162315

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 347003565
Report Date: 02/13/2024
Date Signed: 02/13/2024 04:24:29 PM

Document Has Been Signed on 02/13/2024 04:24 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 HOME		FACILITY NUMBER:	347003565
ADMINISTRATOR:	LOVELACE, DENISE		FACILITY TYPE:	735
ADDRESS:	10320 CANADEO CIR		TELEPHONE:	(209) 353-6037
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95757
CAPACITY:	6	CENSUS: 3	DATE:	02/13/2024
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Denise Lovelace		TIME COMPLETED:	11:09 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A Non-Compliance Conference (NCC) was conducted today on February 1st, 2023, via Microsoft Teams with the Sacramento South Regional Office. The purpose of this NCC meeting was to discuss deficiencies and inability of this facility to remain in substantial compliance with the regulations that have occurred within the last 12 months. Present in the meeting is Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Lisa Rios, and Licensing Program Analyst (LPA) Christina Valerio. Facility representatives include Licensee Denise Lovelace. Alta California Regional Center Representatives include Client Services Manager (CSM) Phil Perez and Residential Service Coordinator (SC) Kara Zwick. During this virtual meeting, the Non-Compliance Conference process was explained to the Licensee. A Non-Compliance Conference Summary (LIC 9111) was generated to document this office meeting. A copy of this report and LIC 9111 was provided to the licensee via e-mail. The facility has previously received 5 Type A citations and 5 Type B citations in the last 5 years. Issues discussed during the Non-Compliance Conference were: · Administrator Qualification/Duties · Personal Rights of Residents in Care · Building and Grounds - Emergency Exits · Building and Grounds - Cleaning Supplies/Other items · Furniture, Fixtures, Equipment, and Supplies - Bathroom/Hygiene supplies · Food Services · Care for Clients Who Lack Hazard Awareness or Impulse Control - Self-closing latches/gates · Cameras in the Facility · TSP Technical Support Program

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 HOME	FACILITY NUMBER: 347003565
	VISIT DATE: 02/13/2024

NARRATIVE

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The Facility Licensee will do the Following:
· Increase Presence in Facility from 20 hours to 40 hours per week.

Licensee to submit updated LIC 500 to LPA Valerio

· Create a Quality Assurance Tool to utilize daily.

Licensee to submit a copy to LPA Valerio on March 1st, 2024

· Complete Mandated Reporting Training with Staff.

Licensee to submit proof of training on March 1st, 2024 and September 1st, 2024

· Conduct In-Service Training for Resident I.P.P and B.I.P. with all Staff

Licensee to submit proof of training on March 1st, 2024

· Continues to collaborate and communicate with Alta California Regional Center and Community Care Licensing

The Regional Office will do the Following:
· Increase monitoring of the facility to every quarter
· Continue to collaborate with Licensee/Facility Administrator

Licensee has been advised that failure to complete the above agreed upon actions by the dates will result in this Department taking the following action(s):
· License Revocation
· Administrator De-certification

Completing the non-compliance conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Codes if such action is deemed necessary by the Regional Manager.

In the event that the Department determines that the licensee has violated the law/regulations or is inadequately implementing the approved plans, the Department, in its discretion, may seek formal legal action or other appropriate administrative action.

An exit interview was conducted via Microsoft Teams and a copy of this report was sent electronically for signature. Licensee to review and send signed copy to christina.valerio@dss.ca.gov

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC809 (FAS) - (06/04)

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