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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002979
Report Date: 08/09/2023
Date Signed: 08/09/2023 11:07:16 AM


Document Has Been Signed on 08/09/2023 11:07 AM - 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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:
08/09/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Karen LimTIME COMPLETED:
11:15 AM
NARRATIVE
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An office meeting was held on 08/09/2023, from 10:30 AM- 11:00 AM at the Sacramento North Regional Office located at: 9835 Goethe Rd Ste 100 Sacramento, CA 95827. The purpose of this meeting was to discuss current concerns the Department has with the management and operation of the facility.

Present in the meeting was Licensing Program Manager (LPM), Laura Munoz, Licensing Program Analyst (LPA), Cassie Yang and Licensee/Administrator, Karen Lim.

Issues discussed during the meeting were:
  • Current Lease Agreement/Control of Property
  • Current pending applications with Centralized Application Bureau
  • Change of Administrator
  • Change of Ownership and/or Facility Closure
  • Staffing

LPM Munoz requested Licensee to provide LPA Yang a current lease agreement and proof of rent payment by Friday 08/11/2023 via email.

As a result of today's meeting, no deficiencies cited as observations are still under review. Exit interview conducted with Licensee and a copy of the report was provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023
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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