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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547201564
Report Date: 10/05/2022
Date Signed: 10/05/2022 11:05:25 AM


Document Has Been Signed on 10/05/2022 11:05 AM - 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, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:LOVING CARE ASSISTED LIVINGFACILITY NUMBER:
547201564
ADMINISTRATOR:PERRY, FEFACILITY TYPE:
740
ADDRESS:1542 E. GLENWOOD AVENUETELEPHONE:
(559) 688-4835
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY:6CENSUS: 4DATE:
10/05/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Licensee Ronald Perry and Administrator Fe PerryTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Lady Cabrera arrived at the facility unannounced to conduct a Health and Safety Visit. LPA met with Licensee Ronald Perry and Administrator Fe Perry. LPA explained the purpose of the visit.

LPA toured the facility inside and out. LPA toured the kitchen and observed required perishable and non-perishable food supply, locked sharps and cleaning supplies. Medication cabinet was locked as well. Resident rooms toured, required furniture and lighting in place. Fire Extinguishers dated 10/03/2022. Administrator Certification date 1/15/2023. House temperature 78 degrees. LPA conducted Health and Safety check on residents in care.

LPA requested Resident's (R1) facility file and LIC 9020 Register of Facility Residents, and Personnel Report with contact information.

No deficiencies cited during this visit.

A copy of this report has been provided and an exit interview provided to Administrator and Licensee.

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 513-9832
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2022
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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