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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803912
Report Date: 07/22/2022
Date Signed: 07/22/2022 09:43:59 AM


Document Has Been Signed on 07/22/2022 09:43 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:A LOVING LIVING HOME CAREFACILITY NUMBER:
486803912
ADMINISTRATOR:LOVELYN HOJILLAFACILITY TYPE:
740
ADDRESS:224 LOCH LOMOND DRIVETELEPHONE:
(707) 469-9029
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:6CENSUS: 3DATE:
07/22/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator, Lovelyn HojillaTIME COMPLETED:
09:55 AM
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On July 22, 2022 at approximately 09:15 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at A Loving Living Home Care for the purpose of conducting a Plan of Correction (POC) inspection. LPA was greeted at the door by Administrator, Lovelyn Hojilla and was granted access into the facility.

During the POC inspection, LPA observed the sliding door alarm leading out to the backyard was tested and operational during the POC inspection. LPA requested Administrator to send a summary of how future compliance as it relates to this regulation will be met moving forward. In addition, LPA toured the facility with the Administrator. During the tour, LPA observed the facility to be clean and at a comfortable temperature with all exits free from obstruction during the inspection. LPA toured the kitchen and found the food to be properly stocked and stored with perishable and non-perishable foods.

No deficiencies were observed or cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator due to printer issues.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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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