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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201124
Report Date: 04/11/2022
Date Signed: 04/11/2022 01:51:05 PM

Document Has Been Signed on 04/11/2022 01:51 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: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:
04/11/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mynette Boykin and MERCEDES BROOMETIME COMPLETED:
03:18 PM
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On 04/11/2022, Licensing Program Analyst (LPA) J. Sampair conducted an announced prelicensing inspection of the facility with Applicant Mynette Boykin. LPA and Applicant completed the prelicensing inspection of the facility.

Pre-Licensing is complete and this facility has no deficiencies.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2022
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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