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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700396
Report Date: 02/12/2025
Date Signed: 02/12/2025 03:17:27 PM

Document Has Been Signed on 02/12/2025 03:17 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:LOVE & CARE FOR ELDER IIFACILITY NUMBER:
342700396
ADMINISTRATOR/
DIRECTOR:		SUIUGAN, ELIZABETHFACILITY TYPE:
740
ADDRESS:7990 COOK RIOLO RDTELEPHONE:
(916) 723-2912
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
02/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Benjamin SuiuganTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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On 02/12/2025 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with staff, Benjamin Suiugan and explained the purpose of the visit

LPA and staff conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to resident bedrooms, bathrooms, kitchen, dining room and common areas. LPA observed sufficient furniture and lighting throughout the facility. LPA observed the facility to have sufficient food supplies for seven (7) day non-perishable and two (2) day perishable. LPA observed toxins, knives and centrally stored medications to be locked and inaccessible to residents in care. All required Licensing posters are present in common area in the facility. Fire extinguishers was last inspected on 10/30/2024. Smoke and carbon monoxide detectors are working and present throughout the facility.

LPA conducted a file review of five (5) resident records and two (2) staff records. All records contained required documents.

LPA requested a copy of the current liability insurance, LIC500 and LIC308 to be sent to LPA Ratajczak by 02/14/2025

LPA completed the full care tool and no deficiencies was observed.

Exit interview conducted and a copy of the report was left at the facility.
Laura MunozTELEPHONE: (916) 263-4743
Cheyenne RatajczakTELEPHONE: (916) 969-7879
DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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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