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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700814
Report Date: 07/12/2022
Date Signed: 07/12/2022 11:27:44 AM


Document Has Been Signed on 07/12/2022 11:27 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:A LOVING PLACE FOR YOUR PARENTSFACILITY NUMBER:
392700814
ADMINISTRATOR:MARTHA ARREGUINFACILITY TYPE:
740
ADDRESS:488 POELSTRA COURTTELEPHONE:
(714) 948-0381
CITY:RIPONSTATE: CAZIP CODE:
95366
CAPACITY:6CENSUS: 0DATE:
07/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ruth Gomez and Brandi VargasTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Avelina Martinez and Arielle Pascua arrived at this facility unannounced on 07/12/2022 at 10:30 AM to conducted a facility closure visit. LPA Martinez and LPA Pascua met with Ruth Gomez and Brandi Vargas and explained the purpose of the visit.

During today's visit, LPA Martinez and LPA Pascua toured the facility. During today's visit, resident 1 was was being transferred to another facility. Resident 1 was accompanied by the assigned responsible party. LPA Martinez and LPA Pascua observe resident 1 leave the facility with the responsible party. In addition, LPA Martinez spoke with the Licensee during today's visit, and discussed the closure of the facility. LPA Martinez also, obtained the facility license during the visit. In addition, LPA discussed facility closure survey with Ruth Gomez, and an exit interview was conducted. A copy of this report was provided to Ruth Gomez.

Closure Survey Link:

www.surveymonkey.com/r/facilityclosure.com

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2022
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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