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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201124
Report Date: 04/01/2022
Date Signed: 04/04/2022 08:16:56 AM

Document Has Been Signed on 04/04/2022 08:16 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:LOVING TOUCH CARE HOMESFACILITY NUMBER:
079201124
ADMINISTRATOR:BROOME, MERCEDESFACILITY TYPE:
740
ADDRESS:285 EBANO DRTELEPHONE:
(510) 719-7770
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 0DATE:
04/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Mynette Boykin and Mercedes BroomeTIME COMPLETED:
06:00 PM
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On 04/01/2022, Licensing Program Analyst (LPA) J. Sampair conducted an announced prelicensing inspection of the facility with Applicant Mynette Boykin and Administrator Mercedes Broome. LPA, Applicant, and Administrator began with the Comp III training. After that training was completed, they continued the prelicensing inspection of the facility inside and outside.

Though many of the deficiencies previously identified had been rectified, Pre-Licensing is incomplete with deficiencies to be resolved by 04/30/2022. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2022
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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