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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201124
Report Date: 04/05/2023
Date Signed: 04/05/2023 06:48:28 PM

Document Has Been Signed on 04/05/2023 06:48 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:
(925) 393-5779
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 4DATE:
04/05/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee Mynette BoykinTIME COMPLETED:
07:00 PM
NARRATIVE
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On 04/05/2023 11:00 AM Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct Post-Licensing inspection visit. LPA met with staff S1 and disclosed the purpose of the visit. S1 called Licensee Mynette Boykin who arrived at 11:40 AM.

LPA and Licensee toured facility inside and outside.

Facility had a 2-day perishable and one week non-perishable food supply.

3 deficiencies triggered comprehensive inspection:
  • Type A: 87303(e)(2) - hot water at 136 degrees F
  • Type B: 87466 - resident progress notes are not being maintained at facility.
  • Type B: 87307(a)(2)(B) - Staff S1 and S2 residing in facility in living room

Inspection incomplete and will be continued at a future date.

Exit interview conducted with staff S2. Copy of this report provided via email for Licensee.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 04/05/2023 06:48 PM - It Cannot Be Edited


Created By: James Sampair On 04/05/2023 at 06:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: LOVING TOUCH CARE HOMES
FACILITY NUMBER: 079201124

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in the kitchen sink at 1:35 PM when measured at 136 degrees F, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/06/2023
Plan of Correction
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By due date, hot water temperature shall be reduced to a safe range of 105 to 120 degrees F. Licensee shall attest to LPA that has been done.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Harpreet Humpal
LICENSING EVALUATOR NAME:James Sampair
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/05/2023 06:48 PM - It Cannot Be Edited


Created By: James Sampair On 04/05/2023 at 06:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: LOVING TOUCH CARE HOMES
FACILITY NUMBER: 079201124

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87466
Observation of the Resident
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above. No progress notes are being recorded, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/12/2023
Plan of Correction
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Licensee shall institute the practice of recording progress notes for residents on a daily basis and then train staff on recording and maintaining those progress notes. LPA shall be sent record of those progress notes and the staff training on or before due date.
Type B
Section Cited
CCR
87307(a)(2)(B)
Personal Accommodations and Services
(2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage, storage area, shed or similar detached building.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, with staff S1 and S2 being allowed to use the living room as a place to sleep, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/19/2023
Plan of Correction
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All staff must move out of facility and Licensee attest to that move on or before the due date to the LPA.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Harpreet Humpal
LICENSING EVALUATOR NAME:James Sampair
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2023


LIC809 (FAS) - (06/04)
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