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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700767
Report Date: 07/28/2020
Date Signed: 04/21/2021 10:00:22 AM

Document Has Been Signed on 04/21/2021 10:00 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:ALLTRUE CARE LLCFACILITY NUMBER:
342700767
ADMINISTRATOR:KACHAN, VICTORIAFACILITY TYPE:
740
ADDRESS:9977 WYLAND DRIVETELEPHONE:
(530) 215-8388
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 5DATE:
07/28/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Victoria KachanTIME COMPLETED:
02:00 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
Announced case management visit, conducted via FaceTime, since a physical visit to this facility was not allowed at this time due to COVID 19 precautionary measures. This LPA was joined by Public Health Nurse Remedios Young, Licensee/Administrator Victoria Kachan, and Licensing Program Manager Stephenie Doub.
Current census was 5 residents.
The purpose of this televisit was to go over the rules and regulations pertaining to public health guidelines and CDSS guidelines in maintaining the facility to be compliance against COVID 19.

The following items were discussed during this televisit:

Proper training for facility representative and staff
Proper hand washing and maintenance of hygiene
PPE supplies and requirements on site
Proper reporting to public health and CCL upon discovery of positive case(s)
Social distancing within the facility
Recreational activities for outdoor exposure for elderly needs
Testing of facility personnel for COVID 19
Quarantine of residents upon discovery of positive case

There were no deficiencies observed or cited during today's case management visit.

Exit Interview
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2020
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