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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920094
Report Date: 05/01/2024
Date Signed: 05/01/2024 10:20:01 AM


Document Has Been Signed on 05/01/2024 10:20 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:
05/01/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Ilona TimofeyTIME COMPLETED:
10:30 AM
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On Wednesday May 1, 2024, Licensing Program Analyst Melissa Parks arrived to conduct an unannounced postlicensing inspection.

LPA reviewed 2 resident and 2 staff files. All resident files contained the required paperwork. Staff files contained the required paperwork and training. Facility is current on fire drills. First aid kit is fully stocked.

LPA toured the facility with Administrator Ilona. The following areas were inspected: backyard, resident rooms, resident bathrooms, kitchen, and common area.

No deficiencies cited. An exit interview conducted. A copy of this report was emailed.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2024
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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