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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701084
Report Date: 10/06/2021
Date Signed: 10/06/2021 01:28:27 PM

Document Has Been Signed on 10/06/2021 01:28 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:R & E SENIOR CARE, INC.FACILITY NUMBER:
342701084
ADMINISTRATOR:PASCUA, EMILY B.FACILITY TYPE:
740
ADDRESS:5231 OLIVEHURST WAYTELEPHONE:
(916) 895-4357
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 6CENSUS: 0DATE:
10/06/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee Emily Pascua, Licensee Randy Pozon, Adminsitrator Grace DelayTIME COMPLETED:
01:30 PM
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On 10-6-21 Licensing Program Analysts (LPA)s Tirzah Hubbard and Christina Valerio conducted a Pre-licensing visit. LPA's met with Licensees Emily Pascau, Randy Pozon, and Administrator Grace Delay Applicant, Marcus Huff, is seeking licensure to accept and retain up to 6 clients at any given time.

A Tour of the facility was conducted.Client rooms and restrooms were toured and in compliance. Furniture and furnishings were observed to be sufficient and in good repair. Hot water temperatures were taken in the restrooms to make sure that they were within the allowed range of 105-120 degrees.First aid kit was reviewed to make sure it contained all of the required components.Fire extinguishers were observed to have been recently purchased, not more than 3 months ago, and located in the kitchen area and another one placed under the kitchen sink. Smoke detectors were reviewed and observed to be functional at this time.
Common rooms were toured. Living room, dining room, and other spaces intended for client use were reviewed and found to be in compliance at this time. Laundry area was observed to have a functional lock to make detergents and other cleaning agents inaccessible to the clients. Garage area was toured.Closet space intended for the storage of client medications and files were reviewed. This LPA did observe 6 separate containers intended for client use. The door for this space was equipped with a functional lock to make it inaccessible to the clients. LPA Reviewed Records and Licensee has hired a new designated administrator Grace Delay. Mitigation plan submitted on 10-6-21.
LPAs discussed mitigation plan and Covid-19 precautionary measures for quarantine procedures. LPAs discusses isolation procedures if a resident test positive.
LPAs went over component III with Licensees and Administrator and asked for any questions to be answered.
Exterior grounds of this facility was toured. Perimeter fence and facility gate were reviewed.Based on the findings of this Pre-licensing visit this Applicant has been found to be in compliance at this time. This application will be forwarded to Licensing Program Manager (LPM) Stephen Richardson for final approval. Upon final approval, LPA Hubbard will contact the applicants.

Exit Interview.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Tirzah Hubbard
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2021
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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