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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700758
Report Date: 04/11/2024
Date Signed: 04/11/2024 02:16:55 PM


Document Has Been Signed on 04/11/2024 02:16 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 COMFORT IIFACILITY NUMBER:
342700758
ADMINISTRATOR:VUNIMATANA, RATUFACILITY TYPE:
740
ADDRESS:320 BOWMAN AVETELEPHONE:
(916) 832-3626
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY:6CENSUS: 5DATE:
04/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:ELIESA QIOLELE - DIRECT CARE STAFFTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection. LPA met with direct care staff and explained purpose of visit. Administrator's Certification Pending..

LPA and direct care staff toured the interior and exterior of the facility including common areas, resident bedrooms, resident bathrooms, staff room, kitchen, dining room, laundry area, and backyard. LPA observed the facility to be clean and in good repair and to have sufficient furniture and lighting throughout. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA observed locked sharps locked cabinet designated for medications. LPA observed grab bars and non-skid flooring in all bathrooms. LPA observed locked toxins. Fire extinguishers were last inspected 1/4/2024. The facility conducts fire/disaster drills with residents on 1/5/2024. Smoke/monoxide alarms are working order. LPA observed a complete First Aid kit on site and measured the hot water at 109.6 *F in the bathroom. LPA observed all doors to have alarms. LPA observed seating on patio and two gates that were locked and accessible. LPA reviewed three resident files and three staff files, including criminal record clearances. A review of staff records indicates all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews.

LPA requested the following updated documents for community care licensing to be submitted via email by April 16, 2024: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, LIC 610E Emergency Disaster Plan, Copy of Administrator's Certificate, and Copy of Liability Insurance. ruth.wallace@dss.ca.gov

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies are being cited.
Exit interview conducted with direct care staff. Copy of reports and (LIC 811 Confidential Names) left at facility.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
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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