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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700814
Report Date: 07/11/2022
Date Signed: 07/11/2022 05:21:18 PM


Document Has Been Signed on 07/11/2022 05:21 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
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: 2DATE:
07/11/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Ruth Gomez and Brandi VargasTIME COMPLETED:
05:45 PM
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Licensing Program Analysts (LPAs) Avelina Martinez and Arielle Pascua arrived at this facility unannounced on 07/11/2022 at 2:30 PM to conduct a Health and Safety case management visit. LPA Martinez and LPA Pascua met with Ruth Gomez and Brandi Vargas and explained the purpose of the visit.

During today's visit, LPAs Martinez and LPA Pascua toured the facility and reviewed facility documents. LPA Martinez and LPA Pascua also, inspected the facility. During the inspection, LPA Martinez and LPA Pascua observed a limited amount of food, and a care staff had to bring additional food to make dinner. Additionally, there was a limited amount of cleaning supplies. The facility has a 12 pack of toilet paper. There is no internet or phone service. The facility has no washer and dryer. The Licensee is currently selling facility furniture and appliances online. Resident room furniture is also being sold. Some of the residents dressers have been sold. The facility also has limited supply of briefs and hygiene products.

The licensee has not visited the facility since July 3, 2022. The facility administrator resigned on July 8, 2022. The Licensee was called during today's visit, and the Licensee did not respond. Furthermore, shift changes were created by a care staff during the visit. There was a shift change at 4 PM, and this shift is from 4PM to 10 AM. A staff is scheduled to start work at 10 AM on 07/12/2022.

Moreover, during the visit, there were 2 residents and 1 care staff. However, LPA Martinez and LPA Pascua were informed one resident would be leaving the facility tonight. The Department will continue to follow up regarding resident placement.

An exit interview was conducted, and a copy of this report was given to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2022
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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