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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003867
Report Date: 09/16/2020
Date Signed: 09/16/2020 02:09:14 PM

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:ELDERLY LOVE CARE HOMEFACILITY NUMBER:
347003867
ADMINISTRATOR:LIBERATO, ELSIEFACILITY TYPE:
740
ADDRESS:5639 BRIDGECROSS DRIVETELEPHONE:
(916) 418-4085
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:6CENSUS: 1DATE:
09/16/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Elsie Liberato, AdministratorTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Bethany Huusfeldt arrived unannounced and met with Administrator, Elsie Liberato. Currently there is 1 resident residing at the facility.
LPA toured the facility with administrator including kitchen, common living spaces, and bedrooms. LPA observed sufficient amount of food available to resident. LPA observed resident medications and documents. Lights in the facility were on and facility had working appliances. Resident reports they are receiving their medications daily. Resident appears to be comfortable and resident reports care is being provided. Facility appears to be clean and in good working order.

LPA received an updated phone number for administrator.

At this time no deficiencies were issued to the facility.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany HuusfeldtTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2020
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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