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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700758
Report Date: 01/09/2024
Date Signed: 01/09/2024 04:30:41 PM


Document Has Been Signed on 01/09/2024 04:30 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:LOVE AND COMFORT IIFACILITY NUMBER:
342700758
ADMINISTRATOR:VUNIMATANA, RATUFACILITY TYPE:
740
ADDRESS:320 BOWMAN AVETELEPHONE:
(916) 832-3626
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY:6CENSUS: 5DATE:
01/09/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:51 PM
MET WITH:Eliesa QuoleleTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analysts (LPA) Pang Lee arrived at the facility on 01/09/2024 at 3:51 PM to conduct an unannounced Plan of Correction (POC) visit. LPA Lee met with direct caregiver Eliesa Quolele, who then called administrator, Ratu Vunimatana to inform that CCLD was present. LPA Lee spoke to the administrator via telephone and explained the purpose of the visit. The purpose of this visit was to verify the plan of correction that was required to be completed on 10/12/2023 for deficiencies that were previously cited on a prior visit conducted on 10/06/2023. Current census was 5.

Based upon this inspection, LPA Lee observed the following:
I. The deficiency cited under Title 22 Regulation 87355(e)(1) has been cleared. It was learned that on 10/13/2023 administrator sent the POC to LPA Jamie Ivey Canady and not LPA Pang Lee. The license did comply with the terms of the POC by POC. A POC letter was generated and provided to the licensee.

II. The deficiency cited under Title 22 Regulation 87405(a) has not been cleared. The license not complied with the terms of the POC by POC due date. A POC letter was not generated and provided to the licensee.

As a result of this case management, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC 809 D page. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 01/09/2024 04:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: LOVE AND COMFORT II
FACILITY NUMBER: 342700758

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/12/2024
Section Cited
CCR
87405(a)

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87405(a) Administrator - Qualifications and Duties
(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours…

This requirement is not met as evidenced by:


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Administrator agrees to read regulation 87405(a) and submit a signed declaration of understanding. The administrator will review LIC 500 Personnel Report for accuracy and ensure the administrator is present at the facility for a sufficient number of hours. The administrator will email POC to LPA Lee by POC due date 01/12/2024 by 5:00 PM end of day.
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Based on interviews, records review and observations, the licensee did not comply with the section cited above. The licensee did not ensure that administrator is at the facility for sufficient number of hours, which poses/posed a potential health, safety or personal rights to person in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024
LIC809 (FAS) - (06/04)
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