486803912-9-20-2023-21-AS-KMOA-CW5MYX-20230929100217

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803912
Report Date: 09/20/2023
Date Signed: 09/20/2023 11:53:16 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2023 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20230828135544

FACILITY NAME:	A LOVING LIVING HOME CARE		FACILITY NUMBER:	486803912
ADMINISTRATOR:	LOVELYN HOJILLA		FACILITY TYPE:	740
ADDRESS:	224 LOCH LOMOND DRIVE		TELEPHONE:	(707) 469-9029
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	6	CENSUS: 5	DATE:	09/20/2023
		UNANNOUNCED	TIME BEGAN:	10:07 AM
MET WITH:	Suzette Hojilla, Lead Staff		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Personal Rights

INVESTIGATION FINDINGS:

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On 9/20/2023, Licensing Program Analyst, Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Lead Staff, Suzette Hojilla. LPA toured the facility, interviewed residents, non-resident individuals, outside parties, conducted facility file review and made observations.

Complaint alleges facility had violated the personal rights of resident (R1). Based on a review of resident medical records, admissions agreements and facility client registry; LPA confirmed that R1 is not an admitted resident residing in the facility. Based on interviews with resident (R2), LPA was informed that the facility staff treat R2 and other residents with dignity and respect. R2 also stated that they have not observed staff or any other individuals in the facility speaking in appropriately while in presence of R2 or any other residents' in care. LPA conducted an interview with non-resident individual (I1) residing in the facility. I1 stated that they were the partner of staff (S1) and not admitted to the facility as a resident. Interview with I1 did not indicate any observation of mistreatment from staff towards the residents.
Continued onto LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20230828135544

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 486803912
	VISIT DATE: 09/20/2023

NARRATIVE

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Interviews with staff (S1 & S2) also explained to LPA that they have positive relationship with residents and other staff with no observations of residents being mistreated by staff. Allegation, personal rights violation is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Appeal Rights given.

Report was reviewed with Lead Staff and copy of the report was provided for Licensee.
No deficiencies cited during visit.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC9099 (FAS) - (06/04)

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