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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920094
Report Date: 01/31/2024
Date Signed: 01/31/2024 11:28:41 AM


Document Has Been Signed on 01/31/2024 11:28 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:LOVE YOU DAD 2 INCFACILITY NUMBER:
315920094
ADMINISTRATOR:TIMOFEY. ILONAFACILITY TYPE:
740
ADDRESS:6200 SWEETGRASS COURTTELEPHONE:
(916) 899-6537
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 5DATE:
01/31/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ilona TimofeyTIME COMPLETED:
12:00 PM
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On Wednesday January 31, Licensing Program Analyst (LPA) Melissa Parks arrived to conduct a prelicensing inspection with residents in care.

LPA reviewed 5 resident files and 4 staff files. All resident files contained the required paperwork. All staff files contained the required paperwork and training.

LPA toured the facility with Administrator Ilona. This facility has a fire clearance for 5 non-ambulatory residents and 1 bedridden resident. There are 5 resident bedrooms and 3 bathrooms. Water temperatures were within the required range. Showers have required nonskid mats. Kitchen is clean and organized. All knives and sharp objects are kept inaccessible to residents. Medications are kept locked in kitchen pantry. Backyard was clear of debris and hazards. Facility has a fully stocked first aid kit.

Component III has been completed at this time with Administrator Ilona.

The facility appears to be in substantial compliance and ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau. An exit interview was conducted with Administrator and a copy of this report will be left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024
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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