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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002096
Report Date: 04/29/2026
Date Signed: 04/29/2026 04:53:55 PM

Document Has Been Signed on 04/29/2026 04:53 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/
DIRECTOR:		MILE, PETREFACILITY TYPE:
740
ADDRESS:7964 RASMUSSEN RD.TELEPHONE:
(916) 705-3318
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY: 6CENSUS: 6DATE:
04/29/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Petre MileTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Melissa Parks arrived on Wednesday April 29, 2026 to conduct a case management visit. LPA met with Licensee Petre and explained the purpose of the visit.

LPA reviewed R1-R5's facility files. Per regulation 87506(d), LPA is removing the following documents:
R1: LIC602
R2: LIC602
R3: emergency contact information, admission agreement, LIC601, LIC602
R4: emergency contact information, Admission agreement, LIC601, LIC602,
R5: LIC602, admission agreement, emergency contact information, LIC601

LPA will return the above files by end of day tomorrow, Thursday April 29, 2026. LPA did not observe admission agreements for R1 and R2. LPA did not observe preadmission appraisals for R1, R2, and R4.. LPA did not observe personal rights (LIC613-C) for R1-R5. Additionally, LPA did not observe reappraisals for R5 and R6.

LPA and Petre toured the facility. LPA did not observe any health, safety or personal rights violations.

see 809-D for deficiencies cited during todays visit.

Exit interview conducted. A copy of appeal right and this report was provided to the Licensee.
NAME OF LICENSING PROGRAM MANAGER: Laura Munoz
NAME OF LICENSING PROGRAM ANALYST: Melissa Parks
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 04/29/2026 04:53 PM - It Cannot Be Edited


Created By: Melissa Parks On 04/29/2026 at 04:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LOOMIS HOME CARE
FACILITY NUMBER: 315002096

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2026
Section Cited
CCR
87507(c)

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87507 Admission Agreements
(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, . . .no later than seven days following admission. This requirement was not met
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Licensee agrees to: have admission agreements signed for R1 and R2 by POC due date.
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as evidenced by R1 and R2 not having signed admission agreements in their resident records. This poses an indirect threat to the health and safety of residents in care.
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Type B
05/13/2026
Section Cited
CCR87467(c)

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87457 Pre-Admission Appraisal
(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs . .this requirement was not met as evidenced by no completed
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Licensee agrees to have preadmission appraisals for R1, R2 and R4 by POC due date.
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preadmission appraisals for R1-R5. This poses an indirect threat to the health and safety of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Laura Munoz
NAME OF LICENSING PROGRAM MANAGER:
Melissa Parks
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/29/2026 04:53 PM - It Cannot Be Edited


Created By: Melissa Parks On 04/29/2026 at 04:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LOOMIS HOME CARE
FACILITY NUMBER: 315002096

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2026
Section Cited
CCR
87468(b)(1)(A)

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87468 Personal Rights
(b) At the time the admission agreement is signed . . .(1) The personal rights of residents (A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be
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Licensee agrees to have LIC613C signed for R1-R6 and kept in resident records by POC due date.
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included in the resident's record. This requirement was not met as evidenced by no signed LIC613-C in R1-R6 facility files. This poses an indirect threat to the health and safety of residents in care.
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Type B
05/13/2026
Section Cited
CCR87463(a)

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87463 Reappraisals
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first . . . This requirement was not met as evidenced by R5 and R6
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Licensee agrees to complete LIC625 for R5 and R6 by POC due date.
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not having reappraisals completed within the last 12 months. This poses an indirect threat to the health and safety of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Laura Munoz
NAME OF LICENSING PROGRAM MANAGER:
Melissa Parks
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2026


LIC809 (FAS) - (06/04)
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