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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002096
Report Date: 09/12/2024
Date Signed: 09/12/2024 10:01:27 AM


Document Has Been Signed on 09/12/2024 10:01 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
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: 3DATE:
09/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Petre MileTIME COMPLETED:
10:10 AM
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Licensing Program Analysts (LPA) Graham Gunby and Kerry Hiratsuka arrived on Thursday September 12, 2024 to conduct the unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (3) and staff (1) files. All resident files contained the required paperwork. All staff files contained the required paperwork. LPAs discussed continuing training to maintain compliance. Facility is compliant with fire drills.

LPAs and Administrator Petre toured the facility together to ensure the health and safety of residents in care. The areas toured included common areas, resident bedrooms, 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 left with administrator.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2024
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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