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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201124
Report Date: 04/21/2023
Date Signed: 04/21/2023 04:48:23 PM


Document Has Been Signed on 04/21/2023 04:48 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:LOVING TOUCH CARE HOMESFACILITY NUMBER:
079201124
ADMINISTRATOR:BROOME, MERCEDESFACILITY TYPE:
740
ADDRESS:285 EBANO DRTELEPHONE:
(925) 393-5779
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 4DATE:
04/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Mynette BoykinTIME COMPLETED:
05:00 PM
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 04/21/2023 at 9:00 AM, Licensing Program Analyst (LPA) J Sampair arrived unannounced for this annual inspection. Upon entry, LPA disclosed the purpose of the visit to Caregiver Hilda Manuel who informed Licensee Mynette Boykin who arrived at 10:15 AM.

LPA inspected the facility inside and outside. Facility has an infection control plan in place that they are following. The designated infection control leader is the administrator. A written Emergency/Disaster plan was posted on the bulletin board for staff, clients and visitors to read. There were at least 7 days of nonperishable and 2 days of perishable foods. Hot water temperature was 107 F and room temperature was 72.0 F. Centrally stored medications were stored in locked cabinets. LPA observed fire extinguisher was fully charged and serviced within the past 12 months. Smoke and Carbon monoxide detectors were operational. Toxic chemicals were stored in locked closets.

2 client and 2 staff interviews were completed in Post-Licensing inspection on 04/05/2023 (refer to LIC 809 from 04/05/2023).

No citations issued.

ADM will send updated copies of the following to LPA on or before 06/01/2023:
ยท Evidence of Liability Insurance

Exit interview conducted and a copy of this report provided via email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2023
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 1