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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201124
Report Date: 02/09/2022
Date Signed: 02/09/2022 03:43:31 PM

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:LOVING TOUCH CARE HOMESFACILITY NUMBER:
079201124
ADMINISTRATOR:BROOME, MERCEDESFACILITY TYPE:
740
ADDRESS:285 EBANO DRTELEPHONE:
(510) 719-7770
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 0DATE:
02/09/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Mynette Boykin and MERCEDES BROOMETIME COMPLETED:
04:00 PM
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On 02/09/2022, Licensing Program Analyst (LPA) James Sampair conducted an announced prelicensing inspection of the facility with Applicant Mynette Boykin and Administrator Mercedes Broome. LPA, Applicant, and Administrator toured the facility inside and outside. During the tour, numerous deficiencies were identified and attached in the 812 report "List of Deficiencies". Pre-Licensing is incomplete with deficiencies to be resolved by 03/31/2022. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies.

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SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
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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