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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700901
Report Date: 12/10/2024
Date Signed: 12/10/2024 03:52:11 PM

Document Has Been Signed on 12/10/2024 03:52 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: 4DATE:
12/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:CaregiversTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 12/10/24, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit and met with caregiver/ designees .

On 11/27/24 the department received a incident report for R1 requiring hospitalization on 11/19/24 for a change in condition. LPA requested resident records and reviewed information provided.

R1 has returned from the hospital and returned to baseline.

LPA advised that PRN medications be documented with date, time, medication, reason and result. Additionally, LPA advised that licensee confirm parameters for physician contact or emergency services when PRNs are not effective as intended. Lastly, R1 has a medication with blood pressure parameters. LPA advised that non-clinician caregivers cannot determine to give or hold a medication based on blood pressure- advised discussing the orders with the physician and have a plan in place for that medication.

As a result of today’s inspection, no deficiencies were noted.


Report reviewed. Copy of report and appeal rights provided
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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