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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600248
Report Date: 11/23/2021
Date Signed: 11/23/2021 10:47:30 AM

Document Has Been Signed on 11/23/2021 10:47 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:LOVE 'N' CARE IIIFACILITY NUMBER:
015600248
ADMINISTRATOR:SHERRY STEWARDFACILITY TYPE:
735
ADDRESS:10419 FOOTHILL BLVDTELEPHONE:
(510) 567-3195
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY: 6CENSUS: 0DATE:
11/23/2021
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sherry Steward, AdministratorTIME COMPLETED:
11:00 AM
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
On 11/24/2021 starting at 9:00 AM, Licensing Program Analyst (LPA) Catherine Lin arrived announced to conduct Infection Control Inspection. Facility has no client currently. LPA met with Administrators Sherry Steward and David Steward, and explained the purpose of the visit.

Upon entry, LPA’s temperature was checked by the Administrator. LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, bathrooms, kitchen, common areas, and outdoor areas. There is one central entry point for universal screening for staff, residents, and visitors. Thermometer and hand sanitizer were observed at screening station. Hand washing posters were observed. Facility staff were observed to be wearing proper PPE.

Administrators were advised to have a sufficient 2-day perishable, one-week non-perishable food supply, and 30-day supply of paper and PPEs before accepting client at facility. Facility maintained supplies at central location and easily accessible for staff. Facility has Mitigation Plan and Emergency Disaster Plan on file.

No deficiency cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2021
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 2