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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202730
Report Date: 08/14/2024
Date Signed: 08/14/2024 02:52:45 PM

Document Has Been Signed on 08/14/2024 02:52 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:LOVEWAYS CARE HOMEFACILITY NUMBER:
435202730
ADMINISTRATOR/
DIRECTOR:
RIZEL DUMONFACILITY TYPE:
735
ADDRESS:3601 EMMANUEL CTTELEPHONE:
(408) 818-0134
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 6CENSUS: 6DATE:
08/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Administrator Rizel DumonTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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On 08/14/2024 Licensing Program Analysts (LPAs) Manuel Monter and Marcela Yanez conducted unannounced visit. LPAs met with Administrator (ADM) Rizel Dumon LPA explained purpose of the visit. LPAs observed 2 staff and 2 residents.

LPA toured the facility inside out with ADM which included; the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. Front yard and backyard were inspected. There was no obstruction to block the walkways. LPAS observed 2 sheds in the backyard used as storage

Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication closet, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 81 degrees F, and hot water temperature was measured at 117 degrees F in both resident bathrooms.

Fire extinguisher was serviced in 09/1/2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on 07/21/2024

LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 1 staff and 1 residents . LPA reviewed 3 residents P &I records

No deficiencies were cited during todays visit. This report was reviewed with ADM Rizel Dumon and a copy of the report was provided.
End of Report
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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