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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701316
Report Date: 12/26/2023
Date Signed: 01/05/2024 12:49:20 PM


Document Has Been Signed on 01/05/2024 12:49 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/05/2024 12:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

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On 12/26/2023 at 10:00 AM, Licensing Program Analyst (LPA) Renee Campbell arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Renee Campbell met both licensee/administrator Laura Moreno De Brown and Christopher Brown. Laura Moreno De Brown will be the Administrator of this facility. The Administrators assisted LPA Campbell in today’s inspection. This Applicant is seeking licensure for a 6-bed Residential Care Facility for the Elderly to accept and retain adult clients at any given time. There were no clients at this time.

The facility has fire clearance for 5 non-ambulatory clients and 1 bedridden client. Bedroom #4 will be used for a bedridden client. Bedroom #1 and #2 and Master Bedroom will be used for non-ambulatory clients. Bedroom #3 will be used for staff only. Water temperature in the bathroom was measured at 109.9 degrees Fahrenheit. The facility administrator’s certificate # 6063851740 is current, and it expires on 12/01/2024. The facility has an infection control plan completed and provided to Licensing for approval.

LPA Campbell inspected the kitchen area. Cabinets and drawers were opened and reviewed at this time. Silverware, plates, and utensils were observed to be sufficient to meet the needs of the clients at this time. Knives, cleaning agents, and bleach were observed to be locked and made inaccessible to the clients at this time. The food storage unit, facility refrigerator, was observed to be functional and in good repair at this time. The freezer temperature was measured at 0 degrees Fahrenheit and the refrigerator temperature was measured at 39 degrees Fahrenheit.

Food supply was reviewed for adequate 2-day perishables and 7-day non-perishable quantities, and they both were observed to be sufficient. Furniture and furnishings were observed to be sufficient and in compliance at this time. The living area, dining area, and all other areas intended for client use were observed to be furnished with a closet, bed, drawers, chair and night stand.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 12/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/26/2023
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


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BROWN LOVING CARE LLC
FACILITY NUMBER: 502701316
VISIT DATE: 12/26/2023
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LPA Campbell observed a telephone made available to clients in the common area.

The facility smoke detectors, combined with carbon monoxide detectors were tested and found to be functioning. Fire extinguishers were observed to be in good condition. The fire extinguisher was purchased on 12/26/2023 and proof of purchase was provided. The linen closet was observed with a sufficient supply of sheets, bedding, pillowcases, and blankets to meet the needs of the clients.

All toxins, sharp objects, and other hazards will be stored in a locked cabinet. The facility laundry room will be locked, as it will store cleaning supplies and other toxins. The facility will not have cameras in the common areas. The exterior of the facility will have cameras. In addition, the facility has a designated room for staff.

The applicants have passed the pre-licensing component of the application process. LPA Campbell will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. Component III was completed during the pre-licensing inspection.

An exit interview was conducted, and a copy of this report was provided to the Applicants.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2