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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700200
Report Date: 04/07/2022
Date Signed: 04/07/2022 12:55:42 PM


Document Has Been Signed on 04/07/2022 12:55 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:LOVE AND SERENITY OF VINTAGE PARKFACILITY NUMBER:
342700200
ADMINISTRATOR:BIANCA G CASTROFACILITY TYPE:
740
ADDRESS:8901 SONOMA VALLEY WAYTELEPHONE:
(916) 509-9693
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: DATE:
04/07/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
11:00 AM
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An office meeting was held on 4/7/22 at 10am on a Microsoft Teams Meeting video conferencing system review the stipulation adopted on 4/4/2022 and the next steps. This Stipulation shall be posted in a conspicuous place at the facility for the duration of the probationary period.

The following were in attendance: Regional Manager Krystall Moore, Licensing Program Manager(s)Stephenie Doub, Liza King, Licensing Program Analyst(s) Victoria Brown, Christina Valero, Jamie Ivey Canady, Christopher Hopkins, Representatives of Love and Serenity LLC, Love and Serenity IV LLC, Love and Serenity Elk Grove LLC, Love and Peace LLC, and Abounding Love LLC, Administrators and Licensees of Love and Serenity, Love and Serenity of Elk Grove II, Love and Serenity of Vintage Park, Love and Serenity IV, Love and Serenity Elk Grove, Love and Peace Home Care, Love and Peace II Elderly Care, Abounding Love Home Care, Love and Serenity II, Javier Castro, Ratu “Pio” Vunimatana, Mike Her, Anthony Camacho, Deborah Saunikalou, Julie Nonu, and Bianca Castro.

Krystall Moore discussed the purpose and elements of this type of meeting.

The Stipulation was reviewed with Representatives, Administrators, and Licensees who expressed their understanding.

Items discussed at the meeting included, but not limited to:
Stipulation contents
· Findings
· Revocation of Licenses and Administrator Certificates/License Application Denials – Not Stayed
· Exclusions- Not Stayed
· Revocations of Licenses and Administrator Certificates/License Application Denials -Stayed with Probation
· Stay of Revocation of Licenses and Administrator Certificate and Exclusion to Facilitate Sale of Facilities
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: LOVE AND SERENITY OF VINTAGE PARK
FACILITY NUMBER: 342700200
VISIT DATE: 04/07/2022
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· Future Application for License, Registration, Certification or Approval
· Licensure, Certification or Approval; Application Denial, Tolling of Probationary Period
· Completion of Probation
· Violation of Stipulation Term
· Department's Authority
· Monitoring Fee
· Waiver of Hearing Rights; Waiver of Appeal/Modification Rights/Waiver of Claims
· Severable terms
· Public Records
· Signatures
· Counterparts
· Effective Date: (4/4/2022 – 4/4/2025)
· No Oral Modification
· Closure intent of Love and Serenity LLC dba Love and Serenity
· Update on Love and Serenity III regarding owner selling the property

The Licensees/Respondents/Representatives stated they would abide by the following:
· Abide by the contents/terms of the Stipulation (submit all documents timely)
· Operate the facility in strict compliance with the regulations and statues governing the operation of a residential care facility for the elderly.

CCLD will do the following:
· Increase monitoring

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations cited during this visit. An exit interview was conducted, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC809 (FAS) - (06/04)
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