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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700090
Report Date: 09/20/2022
Date Signed: 09/20/2022 11:58:57 AM

Document Has Been Signed on 09/20/2022 11:58 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ELK RIDGE OAKSFACILITY NUMBER:
342700090
ADMINISTRATOR:LABIOS, JENNIFERFACILITY TYPE:
740
ADDRESS:8724 ELK RIDGE WAYTELEPHONE:
(916) 685-2392
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 5DATE:
09/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mona Lisa SilapanTIME COMPLETED:
12:15 PM
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Licensed Program Analyst (LPA) Renee Campbell met with Mona Lisa Silapan Administrator #602597740 and Jenny Adoptante, Caretaker on 09/20/22 . LPA stated the purpose of the visit and began the one year required inspection at approximately 9:25 am.

LPA Campbell toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms of which 6 bedrooms are available for the residents and 1 bedroom is occupied by staff. Currently, there are 5 residents. All outdoor and indoor passageways were kept free of obstruction. There were no bodies of water observed. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 109 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 02/03/2022. First aid kit was observed to be complete. Fire drill was last conducted on 09/01/2022. All present staff were cleared. Of the 5 residents present, 3 files were reviewed. LPA Campbell also reviewed 2 of 5 staff files were reviewed. No citations were issued. Appeal Rights and a copy of this report provided. Because Administrator had to leave, permission was given for Bida De Vera to sign this report.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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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