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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005575
Report Date: 08/23/2023
Date Signed: 08/23/2023 01:11:38 PM

Document Has Been Signed on 08/23/2023 01:11 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:A & R QUALITY CARE, LLCFACILITY NUMBER:
347005575
ADMINISTRATOR:AMOR HERNANDEZFACILITY TYPE:
735
ADDRESS:6515 RIO DE ONAR WAYTELEPHONE:
(916) 897-8931
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 4CENSUS: 3DATE:
08/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Amor Hernandez - AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Required 1 Year Annual Inspection. LPA met with administrator and explained purpose of visit. Administrator's Certification expires 9/9/2024. There are currently six residents who reside at this facility.

LPA and administrator inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, medication storage, kitchen, garage and outdoor areas. There is a locked storage for medications. Food supply is adequate for two day perishable and seven day nonperishable. Fire extinguishers were last inspected on November 2, 2023. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. All Fire Exits are free of obstacles and last fire drill was completed on August 19, 2023.

LPA reviewed one staff and one resident files. Resident emergency contact complete. LPA observed all staff and resident files complete. All staff have criminal record clearance and are associated to the facility.

LPA received the following updated documents for master file on today's date:
Designation of Facility Responsibility (LIC 308), Personnel Report (LIC 500), Surety Bond, and Administrator Certificate.

There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

Exit interview conducted with administrator. LIC 811(Confidential Names) and copy of report left at facility.
Stephen Richardson
Ruth Wallace
DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
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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