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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001715
Report Date: 05/23/2022
Date Signed: 05/24/2022 09:37:22 AM

Document Has Been Signed on 05/24/2022 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:CARING FAMILIES-BV2FACILITY NUMBER:
347001715
ADMINISTRATOR:MICHELLE MACIASFACILITY TYPE:
740
ADDRESS:8716 BRAY VISTA WAYTELEPHONE:
(916) 686-0420
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 6DATE:
05/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Lorrena Goodenough, On-call AdministratorTIME COMPLETED:
04:20 PM
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On 05/23/2022 at 2:30 pm, Licensing Program Analysts (LPAs) T. White and R. Campbell arrived unannounced to conduct a Required 1-year annual inspection. LPAs met with Caregiver, Stevie Mudrow and explained the purpose of today’s inspection. LPAs later met with On- Call Administrator, Lorrena Goodenough. LPAs were allowed entry into the facility that is licensed to serve a total capacity of 6 residents.
LPAs toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 77 degrees Fahrenheit. LPAs 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 106 degrees Fahrenheit. There is a minimum of 7-day supply of nonperishable and 2-day perishable foods.

Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguisher was last serviced on February 03, 2022. First aid kit was observed to be complete. Fire drill was last conducted on 05/2022. LPAs reviewed 5 resident files and 3 staff record files.

No deficiencies cited during inspection.

Exit interview conducted with On - Call Administrator and a copy of report emailed..
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2022
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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