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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700876
Report Date: 12/22/2022
Date Signed: 12/22/2022 12:01:08 PM

Document Has Been Signed on 12/22/2022 12:01 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:A LOVING PLACEFACILITY NUMBER:
502700876
ADMINISTRATOR:MARTHA ARREGUINFACILITY TYPE:
740
ADDRESS:2800 CATALA WAYTELEPHONE:
(714) 948-0381
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 6CENSUS: 6DATE:
12/22/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Ruth GomezTIME COMPLETED:
12:10 PM
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LPA Johnson arrived to the facility unannounced to conduct a case management Inspection.

LPA confirmed that staffing is sufficient today and there are no unmet needs for the residents in care. The facility has challenges with staffing and the Administrator is actively advertising and looking for staff.

Currently staff are working doubles and/ or coming in on their days off to continue to meet the staffing needs.

Health and Safety check has concluded for today. The overall safety of the facility including food supply, physical plant and staffing.

The residents in care appear to be comfortable and content with the care being provided.

No deficiencies were cited during the inspection today.

Exit interview conducted.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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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