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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803436
Report Date: 10/11/2024
Date Signed: 10/11/2024 11:05:27 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/11/2024 11:05 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:
10/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Lovely Joseph, via phone
Teri Erole, House Manager		TIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a 1-Year Annual Inspection.

LPA was allowed access into the facility by House Manager, Teri Erole. LPA spoke with Administrator, Lovely Joseph via phone. There are currently no residents in the facility, as Administrator does not plan to operate the facility for the next year or two due to family needs, however they would like to keep their license in good standing.

LPA conducted an inspection and found the facility would need to do several things to be in compliance and be ready for residents: water temperature was 124.8 degrees F, which is not within Title 22 regulation of 105 - 120 degrees F; facility will also need to make sure locks are repaired or installed and utilized in cabinets which store hazardous or toxic materials; fire extinguisher was last serviced on October 11, 2023; and Administrator's Certificate expired on 05/31/2024. In addition, LPA reminded Administrator via phone that licensing fees are due by October 18, 2024.

There was an adequate supply of linens, and 2 rooms had the required furnishings required. Required postings were displayed in entry.

LPA requested the following:
Proof of Current Liability Insurance
LIC500
PIctures of Repaired Locks on Cabinets
Proof of Decreased Water Temperature

LPA requests that Licensee inform CCL when they are ready to begin accepting residents again so that facility compliance can be reviewed.

No citations were issued.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2024
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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