<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003775
Report Date: 01/12/2023
Date Signed: 01/12/2023 03:13:39 PM

Document Has Been Signed on 01/12/2023 03:13 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:LP NUNEZ CARE FACILITY #2FACILITY NUMBER:
347003775
ADMINISTRATOR:NUNEZ, LIONELFACILITY TYPE:
735
ADDRESS:9374 LOS TORRES DRTELEPHONE:
(916) 685-7759
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 4DATE:
01/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:37 PM
MET WITH:Facility staffTIME COMPLETED:
03:15 PM
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
Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to follow up on an incident reported to the department. LPA met with facility staff, and explained the purpose of the visit.

LPA arrived at the facility to follow up on an incident report submitted to LPA. Staff stated the resident did not reside at the facility. Staff called the administrator Lionel whom confirmed that the incident report was for another facility, Nunez Care Home #2.

LPA toured the facility to ensure the health and safety of the residents. LPA did not observe any health or safety concerns. An exit interview was held with staff, and a report was given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1