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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005521
Report Date: 11/22/2024
Date Signed: 11/22/2024 04:01:52 PM

Document Has Been Signed on 11/22/2024 04:01 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:CARE GROUP AT HEATHMAN WAY, THEFACILITY NUMBER:
347005521
ADMINISTRATOR/
DIRECTOR:		LOVELIE P ARCEGAFACILITY TYPE:
740
ADDRESS:9473 HEATHMAN WAYTELEPHONE:
(916) 667-9414
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Monalisa SilapaTIME VISIT/
INSPECTION COMPLETED:
04:15 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) Victoria Brown arrived unannounced to conduct a Case Management visit on 11/22/2024 at 3:15pm. LPA met with Monalisa Silapa, Administrator and stated the purpose of the visit. LPA inquired if staff #1 (S1) was presently on the premises during this visit. Monalisa Silapa stated the staff was cleared but never worked at the facility.

LPA served notice of "ORDER TO LICENSEE/FACILITY OF IMMEDIATE EXCLUSION FROM FACILITY" for S1 who was not present at the time of visit. Monalisa Silapa was advised an immediate removal is warranted and requested the Personnel Report (LIC500) and Guardian account be updated to remove S1 from the facility staff roster. A notice of completion shall be submitted to Community Care Licensing (CCL). LPA provided a copy of the most current Guardian roster during this visit.

LPA informed Monalisa Silapa, Administrator that S1 is not allowed to be employed and/or on any facility premises. The Order to Individual of Immediate Exclusion From All Facilities will be in effect immediately upon receipt of the letter. A copy of the letter was given to the facility during this visit.

The facility understands this is an Immediate Exclusion and has agreed S1 cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services unless otherwise ordered by the Department.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed and cited. Exit interview held, A Copy of report given.
Stephen RichardsonTELEPHONE: (916) 263-4746
Victoria BrownTELEPHONE: (209) 814-1955
DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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