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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601208
Report Date: 01/30/2025
Date Signed: 01/30/2025 05:16:27 PM

Document Has Been Signed on 01/30/2025 05:16 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:HM LOVE & CARE HOMEFACILITY NUMBER:
075601208
ADMINISTRATOR/
DIRECTOR:		RIFORMO, HAILEY R.FACILITY TYPE:
740
ADDRESS:508 KAYANN COURTTELEPHONE:
(510) 222-1406
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY: 6CENSUS: 3DATE:
01/30/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:45 PM
MET WITH:Maria Riformo, Licensee TIME VISIT/
INSPECTION COMPLETED:
05:45 PM
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On 01/30/2025 around 04:45 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a Case Management visit to confirm that an Administrator was on site. LPA met with care staff and Maria Riformo, Licensee (S1) arrived about 10 minutes later.

On 11/01/2024, LPA L. Hall conducted a complaint investigation for 15-AS-20230901131403. At that time, LPA L. Hall observed that the Administrator on record did not have a valid Standard Certified. A deficiency was cited from the California Code of Regulations, Title 22. On 01/07/25, S1 emailed LPA. L. Holmes stating S1 was in the process of completing all the documents and information regarding the change of administrator. LPA L. Holmes reviewed S2 records, and confirmed with CCLD that S2's application was processed and is pending effective 11/18/2024. S1 holds a Standard Certificate 60066016740 exp. 04/06/2025 and will act as the administrator only until the S2's certificate is approved and will provide proof to CCLD.

Exit interview conducted and a copy of this report provided to S1.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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