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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700944
Report Date: 02/11/2025
Date Signed: 02/11/2025 01:35:25 PM

Document Has Been Signed on 02/11/2025 01:35 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:A LOVING SENIOR CARE HOME I LLCFACILITY NUMBER:
312700944
ADMINISTRATOR/
DIRECTOR:		RAMOS, QUEENIE R.FACILITY TYPE:
740
ADDRESS:501 HEATHMORE CT.TELEPHONE:
(510) 427-9904
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 6CENSUS: DATE:
02/11/2025
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Licensee Queenie RamosTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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A meeting was conducted at 11:00am on February 11, 2025, with Sacramento North Regional Office (RO) via Microsoft Teams. Present in the meeting were Licensee, Queenie Ramos, Licensing Program Manager (LPM), Troy Ordonez, LPM Laura Munoz, Licensing Program Analyst (LPA) Graham Gunby and LPA Cassandra Mikkelson.

The purpose of the meeting was to follow-up on the pending change of ownership (CHOW). The Department had concerns regarding the time span for the CHOW and ensuring a smooth transition while staying in compliance. The department has required a letter of notice be given to the residents, staff, and responsible parties.

During today's meeting, the licensee informed the Department of their concerns with the CHOW. The license has informed the department about the application progress and timeline. The Department informed the licensee that follow-up will be needed throughout the application process.

No deficiencies were cited during today’s meeting.

An exit interview was conducted and copy of this report was provided to the licensee via email with request for return with signature.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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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