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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701158
Report Date: 12/04/2025
Date Signed: 12/04/2025 12:36:57 PM

Document Has Been Signed on 12/04/2025 12:36 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:LIVING HOPE ONEFACILITY NUMBER:
342701158
ADMINISTRATOR/
DIRECTOR:		WEI MING ZENGFACILITY TYPE:
735
ADDRESS:4801 34TH STTELEPHONE:
(916) 745-5716
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 12CENSUS: 10DATE:
12/04/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:42 AM
MET WITH:Wei Ming ZengTIME VISIT/
INSPECTION COMPLETED:
12:46 PM
NARRATIVE
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On 12/04/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at the facility to conduct a case management visit. LPA Lee met with Administrator Wei Ming Zeng and explained the purpose of the visit. The census is 10 with 1 staff.

The purpose of this visit is to follow up on fire clearance to the facility fire alarm panel which was reported to LPA Lee by the administrator Zeng during a case management on 09/30/2025; moreover, this visit is to also conduct a quarterly visit. It was learned that the facility had been cited by the Fire Department because the fire alarm control panel was not functioning properly. The malfunction was caused by the Licensee Jacqueline Livingstone turning off the fire alarm control panel, which resulted in system failure. The Sacramento Fire Department also reported that, in the interim, the facility is permitted to continue operating under its current status with a 24-hour third-party fire watch until the issue is resolved since the fire alarm system required permits to reinstate the service. During today’s visit, Code Enforcement Officer K.K. confirmed that the fire alarm is now cleared and in compliance. Moreover, it was learned today that on 03/05/2025 the property owner was issued a letter of violation for the changes made from the approved plans submitted in 2000. The facility made modifications to the kitchen and storage area. The original plans indicated that the storage area was located in the living room, but that it was altered by removing and adding walls to create an enclosed kitchen. As a result, the issue was referred to by the Code Enforcement Team for further action. Due to the modification the facility needed to work with the Building Department to complete a building permit and updated blueprint plans. Additionally, on 11/12/2025, Code Enforcement received an email from the site’s design professional containing plans.



CONTINUED LIC 9099-C
NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Pang Lee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: LIVING HOPE ONE
FACILITY NUMBER: 342701158
VISIT DATE: 12/04/2025
NARRATIVE
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Code Enforcement responded by requesting formal submission of those plans and inquiring whether that submission had already occurred. On 11/13/2025, the Code Enforcement Officer sent a more detailed follow-up email to the site operator and architect outlining the steps required to legalize the layout, required system connections, and the expected timeline. As of 11/13/2025, Code Enforcement had not received any further response from the facility or its design team. On 11/14/2025, LPA Lee contacted Administrator Wei Ming Zeng and advised that the documents must be submitted to Code Enforcement as soon as possible. During today’s visit, Licensee Jackie Livingstone and Administrator Zeng informed LPA Lee and provided documentation confirming that the documents were emailed to Code Enforcement on 11/28/2025 and provided LPA Lee with the application number; however, the submittal was incomplete and that the facility will follow up with code enforcement on this matter. LPA Lee informed the administrator that no alterations may be made to the facility without notifying the department and following the proper permitting procedures. LPA Lee also advised that the facility must report to the department whenever issues arise from the fire department or code enforcement.

LPA Lee conducted a facility tour with Administrator Zeng and inspected the common areas, kitchen, bedrooms, bathrooms, and backyard. Furniture and furnishings were adequate to meet the needs of the clients. The facility temperature measured 68 degrees Fahrenheit, which is within the required range of 68–85 degrees. LPA Lee advised the administrator that although the temperature meets regulatory requirements, the facility must ensure that residents remain comfortable and do not feel cold. The hot water temperature measured 108 degrees Fahrenheit, which is within the required range of 105–120 degrees. LPA Lee observed available first aid supplies and a fully charged, up-to-date fire extinguisher, last serviced on 12/12/2024. LPA Lee reminded the administrator that the extinguisher will soon be due for service and must be service before the 12/12/2025 due date. Carbon monoxide and smoke detectors were observed to be in good repair. In the kitchen, LPA Lee observed sufficient food supplies, including a seven-day stock of non-perishables and a two-day supply of perishables. Locked cabinets were observed for the secure storage of medications, cleaning solutions, and knives. LPA Lee also reviewed five client files and two staff files, all of which were complete.

The following deficiencies were observed and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Fire clearance was already cited on 09/30/2025. The deficiencies can be found on the 809-D page. An exit interview was conducted, and a copy of the 809 report, 809-D page, and appeal rights were given to the facility.

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Pang Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/04/2025 12:36 PM - It Cannot Be Edited


Created By: Pang Lee On 12/04/2025 at 11:57 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: LIVING HOPE ONE
FACILITY NUMBER: 342701158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2025
Section Cited
CCR
80086(a)

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80086(a) Alterations to Existing Building or New Facilities
(a) Prior to construction or alterations, all licensees shall notify the licensing agency of the proposed change.

This requirement was not met as evidence by:
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The licensee has submitted the building permit to the Code Enforcement department on 11/28/2025 and is pending revision from the facility to be resubmitted. The administrator/licensee will notify LPA Lee once the revision has been resubmitted to the code enforcement. No POC will be needed just follow-up on resubmission. .
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Based on interviews and records review the facility made alteration to the facility by creating an enclosed kitchen to the facility. This posed a potential room risk to residents in care.
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Type B
12/12/2025
Section Cited
CCR80061(e)(4)

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80061(e)(4) Reporting Requirements
(e) The items below shall be reported to the licensing agency within 10 working days following the occurrence.
(4) Any changes in the plan of operation which affect the services to clients.

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The facility designated Administrator stated that a review of this cited section, 80061 reporting requirements will be conducted and a statement of understanding of the regulation will be provided to LPA Lee by POC date 12/12/2025 end of day 5:00 PM.
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Based on interviews and reviews of records, the facility made alterations to the building that differed from the approved plans, resulting in a letter of violation from Fire Code Enforcement. The facility also shut off the fire panel, for which it was cited by the fire department. None of these issues were reported to the department in a timely manner.
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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.
Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM MANAGER:
Pang Lee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2025


LIC809 (FAS) - (06/04)
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