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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003775
Report Date: 08/01/2024
Date Signed: 08/01/2024 04:43:39 PM

Document Has Been Signed on 08/01/2024 04:43 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:L.P. NUNEZ CARE FACILITY #2FACILITY NUMBER:
347003775
ADMINISTRATOR/
DIRECTOR:		NUNEZ, LIONELFACILITY TYPE:
735
ADDRESS:9374 LOS TORRES DRTELEPHONE:
(916) 685-7759
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 3DATE:
08/01/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Staff on duty (S1)TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 8/1/24 at 2:40pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to this facility to conduct a Case Management - Annual Continuation visit. The Annual visit was initiated on 7/31/24. LPA met with Staff on duty (S1) and explained the purpose of the visit. Present during this visit were 3 residents in care with 2 staff on duty.

The LPA continued with facility visit to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. LPA reviewed 5 staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. 5 of 5 staff reviewed have current 1st Aid/CPR certificates. 5 of 5 staff reviewed have Direct Support Professional (DSP) training certificates. Administrator certificate for Lionel Nunez is current.

LPA reviewed 3 of 3 resident medications and found to be in compliant. Facility handles resident money. 3 of 3 esidents' P&I money were counted by staff while LPA observed and found to be accurate.

Facility conducts drills on a monthly basis and last drill was conducted 7/4/24.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies were observed or cited. Exit interview held and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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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