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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803263
Report Date: 07/15/2021
Date Signed: 07/15/2021 10:27:24 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:BENICIA LOVING CARE HOME 2FACILITY NUMBER:
486803263
ADMINISTRATOR:GULAPA, LUCITAFACILITY TYPE:
740
ADDRESS:234 MILITARY EASTTELEPHONE:
(707) 590-3555
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY:3CENSUS: 0DATE:
07/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Renter, Cal JoyTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Farhaan Sarangi arrived unannounced to conduct a Case Management inspection. However, during this inspection it was disclosed by the Renter that it is being occupied without any residents in care. Renter disclosed that the Administrator is currently out of the country and is traveling.

The licensee initiated this facility closure, but was not available during this inspection. LPA Sarangi was denied access into the facility by the renter. Upon further observation of the home from the outside, LPA observed no residents in care or in the common area of the homes that was observable via outside.

LPA could not obtain the license from the Administrator. Facility will be closed effective July 15, 2021. Exit interview could not be conducted and a signature could not be secured at this time due to the Administrator being out of the country.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
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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