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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002979
Report Date: 01/27/2023
Date Signed: 01/27/2023 04:11:53 PM

Document Has Been Signed on 01/27/2023 04:11 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:ONLY LOVE ELDERLY CARE HOMEFACILITY NUMBER:
345002979
ADMINISTRATOR:LIM, KARENFACILITY TYPE:
740
ADDRESS:4901 MELVIN DRTELEPHONE:
(808) 228-0588
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 5DATE:
01/27/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Karen LimTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to conduct a pre-licensing inspection with Licensee, Karen Lim. This application is a change in ownership. The facility has a fire clearance for six (6) non-ambulatory residents.

LPA and Licensee conducted an inspection of the care home to ensure compliance with Title 22 regulations. Areas toured included but not limited to: common area, kitchen, bathrooms, bedrooms, laundry room, backyard, storage room. There are two (2) shared resident bedrooms, two (2) private resident bathroom and one (1) shared bathroom for resident use.

LPA observed facility to be properly furnished, including appropriate bedding and lighting in bedrooms. LPA checked the kitchen area for the ability to prepare and store food. LPA observed at least a 2-day perishable and 7-day nonperishable food supply at the facility. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors at the care home are operational.

LPA and Licensee completed the Pre-licensing care tool together and at this time facility is found in substantial compliance.

Component III was completed with Licensee.

Exit interview conducted with Licensee, and a copy of the report was left at the facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2023
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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