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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701316
Report Date: 04/16/2024
Date Signed: 04/29/2024 03:11:51 PM


Document Has Been Signed on 04/29/2024 03:11 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:BROWN LOVING CARE LLCFACILITY NUMBER:
502701316
ADMINISTRATOR:MORENO DE BROWN, LAURAFACILITY TYPE:
740
ADDRESS:6616 GRAYBARK LANETELEPHONE:
(209) 883-7099
CITY:HUGHSONSTATE: CAZIP CODE:
95326
CAPACITY:6CENSUS: 2DATE:
04/16/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Brown L.TIME COMPLETED:
12:15 PM
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On 4/16/2024 Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual visit on this date. LPA met with Jessica Vaquez and explained the purpose of the visit. LPA was later joined by L. Brown.

The facility is a single story structure with wheelchair accessibility. LPA observed all required signage, including license to be prominently posted. LPA toured the facility indoors and outdoors including but not limited to dining room, living room, kitchen, covered garage/ smoking area, 3 bathrooms, 2 bedrooms and backyard. The facility is licensed for 6 clients. (Advisory given for garage.)

Hot water temperature was measured at 112 degrees Fahrenheit in resident's bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers are current and in compliance with fire safety. Carbon dioxide monitor present. Smoke detector are operational . LPA reviewed 2 resident and 2 staff files, including criminal record clearances. All staff today are associated to the facility. First aid kit was checked and is complete. (Advisory given for vitamins.)

An exit interview was conducted and a report was left with the facility with appeal rights.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024
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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