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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342700711
Report Date:
01/26/2024
Date Signed:
01/26/2024 03:07:17 PM
Document Has Been Signed on
01/26/2024 03:07 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:
LOVING CARE SENIOR LIVING
FACILITY NUMBER:
342700711
ADMINISTRATOR:
RONSTADT, STEVEN
FACILITY TYPE:
740
ADDRESS:
4436 JAN DRIVE
TELEPHONE:
(916) 844-7271
CITY:
CARMICHAEL
STATE:
CA
ZIP CODE:
95608
CAPACITY:
6
CENSUS:
6
DATE:
01/26/2024
TYPE OF VISIT:
Post Licensing
UNANNOUNCED
TIME BEGAN:
12:40 PM
MET WITH:
Kelly Conley
TIME COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a required annual inspection. LPA met with House Manager and explained the purpose of the visit.
LPA is conducting an annual inspection today but this report is being generated to clear the Post-Licensing inspection in the system.
There are no citations issued on this report.
Exit interview. Copy of report provided.
SUPERVISOR'S NAME:
Anthony Perez
TELEPHONE:
(323) 485-4915
LICENSING EVALUATOR NAME:
Cassie Yang
TELEPHONE:
(916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE:
01/26/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/26/2024
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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