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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003565
Report Date: 11/30/2022
Date Signed: 11/30/2022 04:10:49 PM

Document Has Been Signed on 11/30/2022 04:10 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:
(209) 353-6037
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 6CENSUS: 4DATE:
11/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Belinda AraujoTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced on 11/30/22 to conduct a case management visit. Upon LPAs arrival, Caregiver Belinda “Bel” Araujo was present and contacted Administrator Denise Lovelace. LPA was advised that Belinda can assist LPA with today’s visit. Administrator holds current certification #6008428735 and expires on 12/7/2023. There are currently 4 clients who reside at this facility.

The purpose of the visit today is in response to substantial inadequacies identified by Alta California Regional Center during an annual Title 17 Monitoring Review on 10/24/2022. It was learned that the facility was placed on sanction on 11/14/2022 due to the following deficiencies:
- Failure to provide consumer services as specified in the consumer’s IPP
- Failure to comply with the requirements for administrator and staff qualifications and/or administrator and staff training.
- Failure to ensure that a direct care staff completes the competency-based
training and testing required
It was learned that the sanction has been lifted on 11/22/2022 as all the items mentioned above have been completed on the Corrective Action Plan.

As a result, the following deficiency was cited from the California Code of Regulations, Title 22, and California Health and Safety Code. The deficiency can be found on the 809-D page.
Exit interview was conducted, and a copy of this report, 809-D, and appeal rights given to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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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Document Has Been Signed on 11/30/2022 04:10 PM - It Cannot Be Edited


Created By: Tung Truong On 11/30/2022 at 03:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ALEGRE LOVELACE CARE HOME
FACILITY NUMBER: 347003565

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2022
Section Cited
CCR
85064(j)(3)(4)

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Adminstrator Qualifications and Duties. The administrator shall perform the following duties…(3) Recruitment, employment and training of qualified staff...(4) Provision of, or insurance of the provision of, services to the clients, required by applicable law and regulation, including those services identified in the client's individual needs and services plans. This requirement is not met as evidenced by:
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Licensee/Administrator will submit to LPA a written statement of understanding regarding Adminstrator Qualifications and Duties regulation 85064 and its requirements by POC due date.
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Based on records review, the licensee did not ensure client's IPP is followed and direct care staff completes the competency-based training and testing as required. This poses an immediate health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME:Tung Truong
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022


LIC809 (FAS) - (06/04)
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