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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201229
Report Date: 01/28/2025
Date Signed: 01/28/2025 03:47:56 PM

Document Has Been Signed on 01/28/2025 03:47 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:LOVELY CARE HOMEFACILITY NUMBER:
435201229
ADMINISTRATOR/
DIRECTOR:
ELIZA DAQUIOAGFACILITY TYPE:
740
ADDRESS:3640 HEATHCOT COURTTELEPHONE:
(408) 531-9515
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
01/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator - Eliza DaquioagTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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On January 28, 2025, at 1:00 PM, Licensing Program Analysts (LPA), Kenneth Madrigal and Manuel Monter, conducted an unannounced annual inspection and met with Eliza Daquioag, Administrator (ADM) and discussed the purpose of the visit. LPAs observed two staff members, and four residents during the visit.
LPAs toured the facility inside and out which included 5 resident rooms, four bathrooms, a living room, a kitchen, a dining area, and staff areas. LPAs toured the front and back of the facility. LPAs observed a shed in the backyard being used a storage area. There were no obstructions that blocked the emergency exit doors.

In the kitchen, LPAs observed that all sharps are in a locked container and that the chemicals are locked in the cabinet. LPAs observed seven-day nonperishable and a two-day perishable food supply. LPAs observed the freezer and refrigerator temperatures recorded within the regulated range. The room temperature is 78 degrees Fahrenheit. The facility water temperature was recorded 109 degrees Fahrenheit.In the hallway, the fire extinguisher was last serviced in January 2025. LPAs observed the emergency fire and earthquake drill logs. The last drill was conducted on December 4, 2024. ADM tested the smoke detectors in the facility.

LPAs reviewed three staff records, four resident records, and four resident centrally stored medication records. LPAs conducted two staff interviews (S2 & S3) and one resident interview (R1).

LPAs provided ADM CDSS changes in regulations for RCFE/Dementia Flyer.

No deficiencies were cited today per today’s visit.

A signed copy of this Evaluation Report was provided to the administrator and was reviewed with the administrator.
Jackie JinTELEPHONE: (714) 319-3786
Kenneth MadrigalTELEPHONE: (669) 660-1606
DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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