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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005575
Report Date: 08/26/2024
Date Signed: 08/26/2024 11:03:19 AM

Document Has Been Signed on 08/26/2024 11:03 AM - 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:A & R QUALITY CARE, LLCFACILITY NUMBER:
347005575
ADMINISTRATOR/
DIRECTOR:
AMOR HERNANDEZFACILITY TYPE:
735
ADDRESS:6515 RIO DE ONAR WAYTELEPHONE:
(916) 897-8931
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 4CENSUS: 4DATE:
08/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Susan PaulinoTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Christina Valerio and Branch Chief Ilyas Hussein arrived unannounced to the facility to conduct an annual required inspection. LPA Valerio and Branch Chief Hussein met with Facility Staff Richard, and explained the purpose of the visit.

LPA Valerio and facility staff toured the physical plant to ensure compliance of Title 22 regulations. LPA Valerio inspected resident bedrooms. Resident bedrooms were observed to be clean, free from debris, and free from odors. Resident bathrooms were clean and fully stocked with hygiene supplies. Hot water temperature was measured at 105.7 degrees F. LPA observed the facility to have extra linens and towels available for use. Fire extinguisher was observed to be fully charged with an annual inspection of 11/03/2024. The facility was observed to have an adequate food supply. Common areas were fully furnished, clean, and organized. Exterior areas were observe to have areas for outside activities and outside visitation. No emergency exit were obstructed. Medications, sharps, and cleaning supplies were locked and inaccessible to residents in care. Residents were observed leaving for their Day Program during the start of the visit. Staff were observed cleaning the home and assisting the RO with the annual visit.

LPA Valerio inspected four (4) resident files and two (2) staff files. Resident files were observed were complete and up to date. Staff files were observed to be up to date with required first aid training and documents.

LPA Valerio requested the following documentation: LIC 500, LIC 308, LIC 610E, Surety Bond, and Administrator Certificate.

Per California Code of Regulations (CCR) - Title 22, no deficiencies are being cited today. An exit interview was held, and a copy of the report was provided to designated staff Susan Paulino.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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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