<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201467
Report Date: 03/20/2025
Date Signed: 03/20/2025 01:57:07 PM

Document Has Been Signed on 03/20/2025 01:57 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:A FAMILY OF LOVE RCFE LLCFACILITY NUMBER:
079201467
ADMINISTRATOR/
DIRECTOR:
MENDOZA, LIWAYWAYFACILITY TYPE:
740
ADDRESS:2754 EASTGATE AVENUETELEPHONE:
(925) 378-9906
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY: 6CENSUS: 0DATE:
03/20/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Dennis Mendoza, Licensee/Applicant
Liwayway Mendoza, Licensee/Applicant
TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 3/20/2025 at 9:30AM, Licensing Program Analysts (LPAs) G. Luk and Y. Brown conducted a Pre-licensing Inspection. LPAs met with Licensees/Applicants, Dennis Mendoza and Liwayway Mendoza.

LPAs toured facility including but not limited to resident's bedrooms, bathrooms, living room, dining area, kitchen, garage, and outdoor area. LPAs observed lighting in all rooms. Hot water was measured at 117 degrees F in the hallway bathroom. Facility bathrooms have grab bars and non-skid mats for the showers. LPAs observed facility have some non-perishable and perishable food supplies available. Facility will purchase additional food supplies once facility is licensed. Carbon monoxide and smoke detectors were observed in operating conditions. Fire extinguishers were observed to be full and last serviced on 3/19/2025. First aid kit was complete.

The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB):

1. LPAs observed bedroom 1's bed is not in good repair without box spring.

2. LPAs observed bedroom 2 is missing chest of drawer.

3. LPAs observed bedroom 2's private bathroom toilet was missing grab bar.

4. LPAs observed bedroom 3's floor near the hallway door has a section where the floor is bubbling.

5. LPAs observed facility only have furniture (a chair, night stand, a lamp or lights sufficient for reading, and a chest of drawers) for 4 residents.

6. LPAs observed facility did not have mattress pads for the resident's beds.

7. LPAs observed facility does not have a land line telephone.

(Continue on LIC809C...)

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: A FAMILY OF LOVE RCFE LLC
FACILITY NUMBER: 079201467
VISIT DATE: 03/20/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
8. LPAs observed LIC610E needs to be updated to address sections regarding "self-reliant", call button (B), refrigeration medications (F), and confirming location (H).

9. LPAs observed facility's dementia plan did not address behaviors such as ingestion of toxic chemicals.


10. LPAs observed facility did not have the following postings: theft & investigative procedures and personal rights.
11. LPAs observed hallway bathroom does not have a paper towel holder.

Licensees/Applicants will submit proof of corrections to CCLD on/before 4/2/2025.

Exit interview conducted with Liwayway Mendoza and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2