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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803906
Report Date: 09/07/2022
Date Signed: 09/07/2022 04:24:56 PM


Document Has Been Signed on 09/07/2022 04:24 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:LUVINHOME,LLCFACILITY NUMBER:
486803906
ADMINISTRATOR:CAMERINO, ANNY K.FACILITY TYPE:
740
ADDRESS:974 SUFFOLK WAYTELEPHONE:
(707) 999-8276
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 2DATE:
09/07/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Anny Camerino, Administrator TIME COMPLETED:
02:15 PM
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The Santa Rosa Regional Office conducted an informal meeting today 09/07/2022 by virtual calling with Luvinhome, LLC . Present in the meeting were: Licensing Program Manager Hope DeBenedetti, Licensing Program Analyst Karina Canela ,Licensee and Administrator Anny Camerino. The purpose of the informal office meeting was to discuss areas of concerns with Luvinhome, LLC facility.

Items addressed during the meeting include, but are not limited to, areas of concern:

  • Compliance with California Title 22 Regulations and Community Care Licensing (CCL) Requirements
  • Resident's Personal Rights
  • Reporting Requirements
  • COVID-19 Requirements
  • Staff training requirements

Additionally, previous informal meeting request was discussed regarding COVID-19 requirements of documenting COVID-19 surveillance testing. Administrator understands this requirement and shall conduct and document surveillance testing for CCL review. Facility hospice waiver request was discussed. TSP assistance was offered as an option to Administrator during this meeting.

*A copy of this report was emailed to Administrator; signature in file.

SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
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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