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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701084
Report Date: 10/20/2022
Date Signed: 10/20/2022 09:37:20 AM

Document Has Been Signed on 10/20/2022 09:37 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:R & E SENIOR CARE, INC.FACILITY NUMBER:
342701084
ADMINISTRATOR:EMILY PASCUAFACILITY TYPE:
740
ADDRESS:5231 OLIVEHURST WAYTELEPHONE:
(916) 895-4357
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 6CENSUS: 3DATE:
10/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Emily Pascua - AdministratorTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection Visit. LPA met with Licensee/Administrator and explained purpose of visit.

LPA and administrator toured the facility. Resident rooms and restrooms were toured and in compliance. Furniture and furnishings were observed to be sufficient and in good repair. Hot water temperature was taken in the kitchen sink 107.2F and it was 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 inspected on 6/23/22. Smoke detectors were reviewed and observed to be functional at this time. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises.
Common rooms were toured. Living room, dining room, and other spaces intended for resident 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 resident medications and files were reviewed. This LPA did observe 6 separate containers intended for resident use. The door for this space was equipped with a functional lock to make it inaccessible to the residents. Mitigation plan submitted on 10-6-21.

Exterior grounds of this facility was toured. LPA observed perimeter fence and facility gate.

LPA reviewed two (2) Staff and two (2) Resident files that were locked and readily available for review. Staff have current first aid/CPR certificates.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed during this visit. Exit interview held with administrator and a copy of report given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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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