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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700901
Report Date: 09/12/2024
Date Signed: 09/12/2024 01:28:59 PM

Document Has Been Signed on 09/12/2024 01:28 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:A LOVING AND JOYFUL HOME RCFEFACILITY NUMBER:
312700901
ADMINISTRATOR/
DIRECTOR:		HEYDON, ANITAFACILITY TYPE:
740
ADDRESS:609 HERNANDEZ LANETELEPHONE:
(916) 918-2429
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 3DATE:
09/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:CaregiversTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 9/12/24, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit and met with Caregivers . Administrator , Anita Heydon, notified and arrived to assist

On 9/9/24, The department received an incident report regarding R1's hospitalization on 8/28/24 and death while hospitalized on 8/31/24.
During todays visit, LPA reviewed and requested copies of R1's records. Records to include LIC 602, centrally stored medication records, medication administration records (including missed/ refused medications), pre-admission records, Resident care/ observation notes , record of physician/ hospital contact, Blood pressure record, and admission agreement. Also requested training records for S1 and S2.
LPA interviewed caregivers and Administrator.

As a result of today’s inspection, no deficiencies are cited at this time.

Report reviewed. Copy of report provided
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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