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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002913
Report Date: 10/29/2024
Date Signed: 10/29/2024 03:13:27 PM

Document Has Been Signed on 10/29/2024 03:13 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:A LOVING ARM HOME LLCFACILITY NUMBER:
315002913
ADMINISTRATOR/
DIRECTOR:
INVIERNO, VERONICA R.FACILITY TYPE:
740
ADDRESS:409 GLIMMER PLACETELEPHONE:
(916) 872-0384
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 6CENSUS: 6DATE:
10/29/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Veronica Invierno, Administrator/LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 10/29/2024 at 02:00PM, an informal conference was conducted virtual via Microsoft Teams Meeting. The purpose of this informal conference meeting is to discuss the complaint findings on 09/19/24. Present in the meeting is, Licensing Program Manager (LPM) Troy Ordonez, Licensing Program Analyst (LPA) Bethany Mirlohi, Licensing Program Analyst (LPA) Cassandra Mikkelson and Licensee/Administrator Veronica Invierno.
The purpose of the informal conference is to have open discussion concerning a complaint that was substantiated for a staff handling a resident in a rough manner and staff speaking to resident in an inappropriate manner. During this meeting the licensee was made aware that this Informal conference is a part of the Administrative Action process.

The informal conference process was explained during this meeting. Issues discussed during the meeting were:

  1. Staffing concerns and training
  2. Administrator qualifications
  3. Recent deficiencies
  4. Facility records
  5. Personal accommodations and services
To support the facility maintaining substantial compliance with Health and Safety Statute and Title 22 regulations, the Department is developing a plan with the licensee to address causes for concerns.
Plan to address compliance concerns by 11/19/2024:
1. Training for staff to include reporting requirements, emergency protocols, and managing dementia behaviors.
The department will provide additional case management visits and complete a referral to TSP (Technical Support Program).
An exit interview was conducted with administrator. Copy of this report was provided to Administrator via email with request for return with signature.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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