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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600760
Report Date: 07/23/2026
Date Signed: 07/23/2026 03:09:07 PM

Document Has Been Signed on 07/23/2026 03:09 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:HEAVENLY CARE, LLCFACILITY NUMBER:
075600760
ADMINISTRATOR/
DIRECTOR:		HUGHES, FELECIAFACILITY TYPE:
740
ADDRESS:2700 LOTUS COURTTELEPHONE:
(925) 978-0496
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 6CENSUS: 6DATE:
07/23/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Felecia Hughes, Administrator
Arvin Perez, Caregiver
Melisa Cabaddu, Caregiver		TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 07/23/26 at 1PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with staff (S1) and spoke to administrator on the phone who authorized S1 to act on her behalf and sign the reports. LPA explained the purpose of the visit with ADM and S1. ADM has current administrator certificate# 7000732740 which expired 04/19/27.

At 1:15PM, LPA inspected including, but not limited to, living room, bathrooms, bedrooms, kitchen, dining area, garage and outside areas. Facility has four (4) bedrooms and three (3) bathrooms. One bedroom and one bathroom designated for staff use only. 2 day perishable and 7 day non-perishable food supply available. Sufficient lighting and furnishing observed. Ample linens and toiletries available. Medications, toxins and sharps stored locked. There were no bodies of water present during inspection. Facility maintained a temperature of 74 degrees, F. Hot water temperature in a resident's bathroom measured at 119 degrees, F. Carbon monoxide detector, fire extinguisher and smoke detectors observed operational and fully charged. LPA reviewed 2 staff and 5 resident files. Licensee does not handle resident's cash resources.

Updated copies of the following documents were obtained during visit:
 LIC500- Personnel Report
 Residents Roster
 LIC308- Designation of Facility Responsibility
 Evidence of Liability Insurance

Continued on 809-C
Bennett Fong
Daisy Panlilio
DATE: 07/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2026
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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Document Has Been Signed on 07/23/2026 03:09 PM - It Cannot Be Edited


Created By: Daisy Panlilio On 07/23/2026 at 02:32 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: HEAVENLY CARE, LLC
FACILITY NUMBER: 075600760

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2026
Section Cited
CCR
87470(5)(A)

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A tissue shall be disposed of in the nearest waste receptacle with a tight-fitting cover immediately after use
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By POC due date, ADM agrees to submit proof of purchase of trash bins with foot operated lid to CCLD in compliance with Section 87470 (5)(A) infection control regulations.
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This requirement was not met as evidenced by open trash bins used by R1, R2, R3 in their bedrooms whoch posed a potential health & safety risk to residents in care
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Type B
07/23/2026
Section Cited
CCR87212(b)

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The plan shall be subject to review by the Department and shall include...(A thru G)...
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By POC due date, ADM agrees to complete and submit to CCL copies of reviewed and signed Emergency/Disaster/Infection control plans in compliance with Section 87212 (b) regulations.
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This requirement was not met as evidenced by Emergency/Disaster plan including infection control plan not reviewed and signed for 2026 which posed a potential health & safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bennett Fong
NAME OF LICENSING PROGRAM MANAGER:
Daisy Panlilio
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/23/2026


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: HEAVENLY CARE, LLC
FACILITY NUMBER: 075600760
VISIT DATE: 07/23/2026
NARRATIVE
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The following deficiencies were observed during visit:
  • At 1:20PM, LPA observed open trash bins in R1, R2, R3's bedrooms
  • At 1:45 PM, Emergency/Disaster plans including infection control plans not reviewed and signed for 2026


Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.

NAME OF LICENSING PROGRAM MANAGER: Bennett Fong
NAME OF LICENSING PROGRAM ANALYST: Daisy Panlilio
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2026
LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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