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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002979
Report Date: 09/05/2023
Date Signed: 09/05/2023 02:18:54 PM


Document Has Been Signed on 09/05/2023 02:18 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 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: 3DATE:
09/05/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Karen LimTIME COMPLETED:
02:30 PM
NARRATIVE
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An office meeting was held at the Sacramento North Regional Office at 9835 Goethe Road, Suite 100. Licensing Program Analysts (LPA's) Cassie Yang and Cheyenne Ratajczak and Licensing Program Manager (LPM) Troy Ordonez met with Licensee, Karen Lim, regarding the status of the facility.

Licensee asked for clarity if licensure is getting revoked by the Department and additionally, if Licensee is able to submit furture applications. LPM explained to Licensee that any applicants are able to submit applications with Centralized Application Bureau; however, the Department will check on applicants compliance history prior to licensure.

Additionally, LPA explained to Licensee that an office meeting was held on Friday September 1, 2023 with Licensing Program Manager (LPM) Laura Munoz which she explained that if Licensee's continues to be in noncompliance, it may affect Licensee's future applications.

As a result of today's meeting, no deficiency cited.

Exit interview conducted, 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: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2023
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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