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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004505
Report Date: 08/06/2024
Date Signed: 08/06/2024 02:48:21 PM


Document Has Been Signed on 08/06/2024 02:48 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:ALL CARE, LLCFACILITY NUMBER:
347004505
ADMINISTRATOR:RAY GINFACILITY TYPE:
740
ADDRESS:5901 WITT WAYTELEPHONE:
(916) 714-5170
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 6DATE:
08/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Ray GinTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required visit. LPA met with facility staff Mei, and explained the purpose of the visit. LPA was later met by Administrator Ray Gin.

LPA Valerio and facility staff toured the physical plant to ensure compliance with Title 22 regulations. LPA observed resident bedrooms, which were observed to be clean, free from odors, and free from debris. LPA observed resident bathrooms to be fully stocked and clean. Linen closet was fully stocked with clean linens and towels. Toxins, cleaning supplies, sharps, and medications were locked and inaccessible to residents in care. The kitchen and dinning area was observed to be clean. Staff were observed cleaning up from meals, assisting home health visits, and assisting residents with ADLs. The facility was observed to have a minimum of a two day supply of perishables and seven day supply of nonperishable food items. The temperature inside the home was observed to be at 78*F degrees. Hot water was measured to deliver 106.3 *F degrees. No emergency exits were obstructed.

LPA Valerio observed 2 staff files and 3 resident files. Files were observed to be up to date and current.
LPA requested the following be sent to LPA Valerio by 08/13/2024: LIC 500, LIC 308, LIC 610, and Copy of liability insurance

Per California Code of Regulations (CCR) - Title 22, no deficiencies were observed during today's visit. An exit interview was held, and a copy of the report was provided to Administrator Ray Gin.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
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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