<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803436
Report Date: 09/16/2022
Date Signed: 09/19/2022 08:30:57 AM


Document Has Been Signed on 09/19/2022 08:30 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:SAFE & LOVING SENIOR CAREFACILITY NUMBER:
486803436
ADMINISTRATOR:JOSEPH, LOVELYFACILITY TYPE:
740
ADDRESS:1647 VANDENBERG CIRCLETELEPHONE:
(707) 384-3911
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:4CENSUS: 0DATE:
09/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Lovely JosephTIME COMPLETED:
03:12 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Katrina Walters arrived at Safe & Loving Care Facility for the purpose of conducting a Required 1-year inspection. LPA was greeted by Administrator, Lovely Joseph(LJ) # 6016407740 exp 05/31/2022. There were no residents in care at the time of inspection. Per LJ they have submitted a request to have their Administrator Certificate updated, but have not yet received their updated certificate. LPA verified through the Administrator Certificate bureau that the certificate is pending.

LPA conducted a walk-through of the interior and exterior portions of the facility with the Administrator. The Administrator has prepared for the infection control of this facility by:
  • Developing a sanitizing station outside of the facility.
  • 30 day supply of personal protective equipment (PPE), incontinence products, cleaning supplies and emergency food.
  • Developed infection control procedures
  • Glove and hand sanitizer stations in resident bedrooms

Fire Extinguisher was found to be last charged on August 10, 2020 at the time of the visit. Facility smoke detectors were found to be functioning properly. Administrator was unable to locate carbon monoxide detector.

Prior to accepting residents, the Administrator will make the following updates:
  • Post signs throughout the facility to promote hand washing and social distancing.
  • Conduct infection control training for staff.
  • Carbon monoxide detector and fire extinguisher will be charged prior to accepting residents. Administrator contacted fire inspection company to have fire extinguisher inspected. Administrator will send LPA a copy of the carbon monoxide detector by Tuesday, 9/20/22 and copy of the fire extinguisher tag by 9/23/22, as proof that the fire extinguisher is charged. There are no residents in care, therefore there is no threat to residents health and safety.
  • Post updated Administrator Certificate.
There were no deficiencies cited during today's visit.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1