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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209073
Report Date: 11/22/2021
Date Signed: 11/23/2021 08:13:18 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/23/2021 08:13 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:MARIA LOVING CAREFACILITY NUMBER:
247209073
ADMINISTRATOR:PELAYO, CHRISTINA MFACILITY TYPE:
740
ADDRESS:1115 PAYNE AVENUETELEPHONE:
(209) 733-8136
CITY:GUSTINESTATE: CAZIP CODE:
95322
CAPACITY: 6CENSUS: 0DATE:
11/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria Drumonde - LicenseeTIME COMPLETED:
11:30 AM
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On this date, Licensing Program Analyst (LPA) arrived at the facility unannounced to conduct an Annual Required Inspection. LPA met with Licensee Maria Drumonde and announced the purpose of the inspection.

Facility was observed at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. There was adequate lighting and seating in the common area. Fire extinguisher were observed to be fully charged and serviced. First Aid kit was observed with the required supplies. The kitchen was toured. Emergency food supply was also observed. Resident rooms were observed to be adequately furnished with bed, dresser, and adequate lightning. Bathrooms were properly equipped with non-skid mats and securely fastened grab bars. There were no residents residing in the facility.

No deficiencies were cited during the inspection. A copy of the report was provided to the Licensee via email.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2021
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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