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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002096
Report Date: 08/31/2023
Date Signed: 08/31/2023 03:36:52 PM


Document Has Been Signed on 08/31/2023 03:36 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:LOOMIS HOME CAREFACILITY NUMBER:
315002096
ADMINISTRATOR:MILE, PETREFACILITY TYPE:
740
ADDRESS:7964 RASMUSSEN RD.TELEPHONE:
(916) 705-3318
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY:6CENSUS: 5DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Petre MileTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Thursday August 31, 2023 to conduct the unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (5) and staff (1) files. All resident files contained the required paperwork. All staff files contained the required paperwork. Facility is complaint with fire drills.

LPA and Administrator Petre toured the facility together to ensure the health and safety of residents in care. The areas toured included resident apartments, resident bathrooms, kitchen, and backyard. Facility has all required postings. All water temperatures were within the required range. Facility has a fully stocked first aid kit. In the areas toured, there were no health or safety violations observed.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023
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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