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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003565
Report Date: 05/30/2024
Date Signed: 05/30/2024 03:44:21 PM


Document Has Been Signed on 05/30/2024 03:44 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:LOVELACE, DENISEFACILITY TYPE:
735
ADDRESS:10320 CANADEO CIRTELEPHONE:
(209) 353-6037
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 3DATE:
05/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Zana Mitchell TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct an annual required visit. LPA Valerio was met by Designated Staff Zana Mitchell, and explained the purpose of the visit.

LPA Valerio observed three (3) residents and two (2) staff on shift. LPA Valerio toured the facility to ensure compliance with Title 22 regulations. LPA Valerio inspected 4 resident bedrooms. Bedrooms were observed to be fully furnished and free from odors. Common areas were clean, free from debris, free from odors, and were fully furnished. Resident bathrooms were stocked with toilet paper, paper towels, hand soap, hand sanitizer. and a trash can. LPA Valerio observed staff reminding residents to practice good hand hygiene after using the restroom. Resident's currently do not have access to the upstairs area of the home, and it is currently not utilized by facility staff. The exterior area was observed. The shed is being utilized for storage. No emergency exits were obstructed or blocked. The kitchen area was observed to be clean. The facility met requirements of a two day supply of perishable items and seven day supply of non-perishable food items. It was observed that residents have access to the refrigerator.

Facility staff were observed providing snacks for the residents, assisting residents with activities, engaging in conversations with residents, assisting in cleaning laundry, and preparing dinner for the evening. Residents were observed to be in a happy, engaging mood, eating snacks, watching television, playing with their electronic devices, and talking to staff. Facility staff showed pictures of their recent outing to the park.

LPA Valerio reviewed two (2) staff files and three (3) resident files. Files were observed to be current and complete. LPA observed the fire detectors, carbon monoxide detector, heath and air condition systems to be in working condition. The last fire drills were conducted on 04/15/24 and 05/24/24. LPA requested the following annual documentation: LIC 500, LIC 308, LIC 610, and Copy of Surety Bond

Per California Code of Regulations (CCR) - Title 22, Division 6, no deficiencies were observed today. An exit interview was held, and a copy of report was provided to designated staff.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2024
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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