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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701339
Report Date: 09/26/2024
Date Signed: 09/26/2024 02:41:01 PM

Document Has Been Signed on 09/26/2024 02:41 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CARE HOME PARTNERSFACILITY NUMBER:
342701339
ADMINISTRATOR/
DIRECTOR:		LABIOS, JENNIFERFACILITY TYPE:
740
ADDRESS:10019 WATERFIELD DR.TELEPHONE:
(916) 667-9147
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 6CENSUS: 1DATE:
09/26/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Jennifer LabiosTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a post-licensing visit. LPA Valerio met with Administrator Jennifer Labios, and explained the purpose of the visit.

LPA Valerio observed 1 resident and 1 staff present in the facility. LPA Valerio and Administrator Jennifer toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed the common areas to be clean, free from odors, and organized. Resident bedrooms were clean and fully furnished. Bathroom water temperature was within regulatory range. The facility was observed to meet the requirements of 2 days of perishable food items and 7 days of non-perishable food items. Emergency exits were free from obstructions.

LPA Valerio reviewed one (1) staff file and one (1 resident file). Files were observed to have necessary documentation.

Per California Code of Regulations (CCR) - Title 22 - no deficiencies were observed. An exit interview was held, and a copy of the report was provided to Administrator Jennifer Labios.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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