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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700678
Report Date: 01/19/2023
Date Signed: 01/19/2023 03:16:01 PM

Document Has Been Signed on 01/19/2023 03:16 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:LOVING CARE SENIOR LIVING IIFACILITY NUMBER:
342700678
ADMINISTRATOR:RONSTADT, STEVENFACILITY TYPE:
740
ADDRESS:4021 FAIRWOOD WAYTELEPHONE:
(916) 944-4969
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 2DATE:
01/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Kelly ConleyTIME COMPLETED:
03:30 PM
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On 1/19/23, Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced case management visit. LPA met with Steven Ronstdt and Kelly Conly and explained the purpose of the visit. Prior to the visit, LPA completed required COVID-19 testing protocols. LPA completed a facility risk assessment upon arrival. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility.)

The purpose of this inspection was to follow-up on a recent resident death

LPA interviewed licensee and administrator and requested the following records for R1: LIC 602, LIC 625 Needs and services plan, records of recent medical care (12/27/22- 1/12/23) and death certificate. Records to be submitted by 1/27/23.

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



Report reviewed and copy provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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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