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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801936
Report Date: 04/29/2022
Date Signed: 04/29/2022 12:18:21 PM

Document Has Been Signed on 04/29/2022 12:18 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:LOVEJOY'S GREENHOUSEFACILITY NUMBER:
496801936
ADMINISTRATOR:LOVEJOY, MARTHAFACILITY TYPE:
740
ADDRESS:3260 HIDDEN VALLEY DRIVETELEPHONE:
(707) 526-7321
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 6CENSUS: 4DATE:
04/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:38 AM
MET WITH:Licensee, Martha LovejoyTIME COMPLETED:
12:30 PM
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Licensing Program Analyst Willis arrived unannounced and met with Licensee, Martho Lovejoy.

During interview regarding an active complaint, LPA learned that facility has a resident who is unable to shift or turn themselves in bed. Further review of resident LIC602 Physician's Report, confirmed that the resident is bedridden.

Facility does not have a bedridden fire clearance. In order to request a bedridden fire clearance, the following documents are to be sent to CCL no later than 4/30/2022:
  • An LIC200 filled out entirely showing 1 bedridden in section 10B
  • An updated facility sketch identifying bedridden room.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Willis
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2022
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 2
Document Has Been Signed on 04/29/2022 12:18 PM - It Cannot Be Edited


Created By: Victoria Willis On 04/29/2022 at 11:47 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LOVEJOY'S GREENHOUSE
FACILITY NUMBER: 496801936

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/29/2022
Section Cited
CCR
87606(c)

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87606 Care of Bedridden Residents
To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a).
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Licensee agrees to submit an updated LIC200 and Faciilty sketch as described in the LIC809 by POC due date, 4/29/2022.
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Requirement has not been met as evidenced by: Based on interview and document review, Licensee did not comply with the above regulation by retaining a bedridden resident without an approved bedridden fire clearance. This is an immediate risk to the health and safety of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Hope DeBenedetti
LICENSING EVALUATOR NAME:Victoria Willis
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2022


LIC809 (FAS) - (06/04)
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