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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700758
Report Date: 05/23/2023
Date Signed: 05/24/2023 03:25:33 PM


Document Has Been Signed on 05/24/2023 03:25 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: 6DATE:
05/23/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ratu VunimatanaTIME COMPLETED:
12:00 PM
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A Non-Compliance Conference (NCC) was conducted today on May 23, 2023 via Microsoft Teams with the Sacramento South Regional Office. Present in the meeting is Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Czarrina Camilon-Lee, Licensing Program Manager Stephen Richardson, Licensing Program Analyst Laura Muoz, Licensing Program Analysts (LPA) Avelina Martinez, Licensing Program Analyst Pang Lee, and the Licensee of Love and Comfort II, Ratu Vunimatana. During this virtual meeting, the Non-Compliance Conference process was explained to the Licensee.

Since 2022, Love and Comfort II Facility has received seven citation. The facility was cited for the following issues Incidental Medical and Dental; Maintenance and Operation; Personal Rights; Observation of The Residents; Basic Services; Reporting Requirements; and Residential Care Facility for The Elderly. The facility has received three B citations and four A citations since 2021.

Issues discussed during the meeting were:
  • Licensee/Administrator accountability
  • Lack of care and supervision for all residents in care
  • Timely medical attention for all residents in care.
  • The amount of complaint's filed against this facility within the last 12 months
  • Retention and acceptance and computability of all residents in care.
  • Compliance after citations
  • Reporting requirements



continued
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023
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 COMFORT II
FACILITY NUMBER: 342700758
VISIT DATE: 05/23/2023
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The facility has stated they will do the following to achieve continued and substantial compliance:
  1. Ensure facility has sufficient staff to meet the needs of all residents in care.
  2. The facility Administrator will be on duty at facility for no less than 40 hours per week.
  3. Ensure facility staff are seeking timely medical attention for all residents in care.
  4. Ensure facility staff are completing reassessments and reporting change in conditions in a timely manner to Community Care Licensing Department, primary care physicians, and responsible parties.
  5. Ensure facility staff are reporting to Community Care Licensing and residents' responsible Parties
  6. Ensure facility staff receive incidental and medical training.
  7. Ensure facility staff are completing Medication Administration Records (MAR).
  8. Ensure facility stays incompliance with acceptance and retention and compatibility.
  9. All staff training shall be completed by June 26, 2023. Training documents should be emailed to LPA Martinez on June 26, 2023 by 5 PM. (Training includes the following: Incidental and Medical, reassessments, pre-placement appraisal, basic services, and reporting requirements)
In addition, at this meeting the notified Licensee/Administrator was advised future non-compliance regarding the above and other regulatory components will result in additional citations, civil penalties, and further potential administrative action.

Community Care Licensing Department (CCLD) will do the following:

  • Increase Monitoring to quarterly visits.
  • Technical Support Program (TSP) referral. (Licensee accepted TSP services, and a referral will be completed by CCLD)

Completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager.

Per California Code of Regulations (CCRs) - Title 22 no deficiencies are being cited during this visit. An exit interview was conducted with Ratu Vunimatana and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
LIC809 (FAS) - (06/04)
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