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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003636
Report Date: 08/06/2024
Date Signed: 08/06/2024 12:51:28 PM


Document Has Been Signed on 08/06/2024 12:51 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:MIRALEX ELDERLY CARE HOMEFACILITY NUMBER:
347003636
ADMINISTRATOR:MCMAHON, NANCY MAEFACILITY TYPE:
740
ADDRESS:8376 DANDELION DRIVETELEPHONE:
(916) 896-0720
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:4CENSUS: 0DATE:
08/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Nancy McmahonTIME COMPLETED:
01:00 PM
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On 8/6/24 at 11:15am, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct a case management visit. LPA met with facility Administrator, Nancy McMahon, and explained the purpose of the visit. On 8/5/24, the Department received a phone call from Administrator that she intends to close this facility and informed that all residents have moved out.

During this visit, LPA conducted inspection of 3 of 3 resident bedrooms with Administrator and observed all bedrooms to be vacant and no evidence of residents currently living at this facility.

Per interview with Administrator, a written eviction notice were not provided to residents regarding the closure. Additionally, Administrator has not submitted a closure plan to the Department.

During this visit, LPA provided assistance to Administrator on the closure and eviction procedure. LPA provided the Health and Safety Code Section 1569.682 for Administrator to review. Additionally, LPA provided Closure Roster form for Administrator to fill out and submit to the Department.

An exit interview was conducted with Nancy and a copy of this report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Arvin VillanuevaTELEPHONE: 916-208-0023
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2024
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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