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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201168
Report Date: 08/28/2024
Date Signed: 08/28/2024 12:54:14 PM

Document Has Been Signed on 08/28/2024 12:54 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:GENUINE LOVE CARE HOMEFACILITY NUMBER:
019201168
ADMINISTRATOR/
DIRECTOR:		DIMAGULA,HAROLD & EMELITAFACILITY TYPE:
740
ADDRESS:22947 FULLER AVE.TELEPHONE:
(510) 274-5207
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 5CENSUS: 1DATE:
08/28/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Emelita Dimaguila/AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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On this day, August 28, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct proof of correction (POC) visit. LPA met with Emelita Dimaguila, administrator, and informed the reason for LPA's presence.

On August 20, 2024, LPA issued citation for deficiency section # 87465(a) for R1's 3 medications with POC to be submitted by August 21, 2024. The administrator submitted proof for 2 medications only. The POC for 40 mg of Pantropazole is still not submitted until this date. A civil penalty is assessed for $100.00 per day and will continue until corrected,

Civil penalty = $100.00/day x 7 days (August 22, 2024 to August 28, 2024) = $700.00

Civil penalty was discussed with the administrator.

Exit interview conducted. Appeal Rights, LIC421FC Civil Penalty Assessment, and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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