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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700901
Report Date: 05/16/2022
Date Signed: 05/16/2022 04:04:36 PM

Document Has Been Signed on 05/16/2022 04:04 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:A LOVING AND JOYFUL HOME RCFEFACILITY NUMBER:
312700901
ADMINISTRATOR:HEYDON, ANITAFACILITY TYPE:
740
ADDRESS:609 HERNANDEZ LANETELEPHONE:
(916) 200-8447
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 6DATE:
05/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Anita HeydonTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility today and met with the Administrator, Anita, to follow-up on a incident report received on 5/13/22. Facility currently does not have any COVID-19 positive cases. LPA wore N-95 masks and were screened by facility upon entry. Facility staff wore masks in the care home.

The incident involved R1 leaving without assistance on 5/6/22. R1 left the home without assistance to an area convenience store. R1 was found by caregiver and returned to the facility.

During today’s visit, LPA interviewed staff and and resident and reviewed resident records.
Resident and representative are currently seeking an updated 602 that more accurately describes their recovered condition.

In addition to the updated 602, licensee will hold a care conference with the resident and update their care plan.

While LPA was present, Fire doors were found propped with door stops. Stops were removed and alternatives were discussed. Technical violation notice provided.

No deficiencies are cited at this time.

Exit interview conducted. A copy of this report has been provided to facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022
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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