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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701533
Report Date: 06/18/2025
Date Signed: 06/18/2025 04:58:47 PM

Document Has Been Signed on 06/18/2025 04:58 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ALL OUR LOVE SENIOR HOME, INCFACILITY NUMBER:
342701533
ADMINISTRATOR/
DIRECTOR:		PANEN, ERICAFACILITY TYPE:
740
ADDRESS:30 TEARPAK CTTELEPHONE:
(916) 479-3916
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 6CENSUS: 2DATE:
06/18/2025
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:16 PM
MET WITH:Erica PanenTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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On 06/18/2025, Licensing Program Analyst (LPA) Pang Lee made an unannounced visit to this facility to conduct a post required inspection. LPA Lee met direct care staff Imelda Panen and explained the purpose of the visit. Facility staff called to informed Administrator Erica Panen that CCLD was present. Administrator arrived at the facility approximately two hours later to assist the visit.

The facility has a fire clearance to accommodate six non-ambulatory residents, including approval for one bedridden resident in room #3, and is licensed for two hospice waivers. LPA Lee was met by Ombudsman Byron Toliver. Together, LPA Lee, Ombudsman Bryon and Imelda inspected the physical plant, including but not limited to the kitchen, dining room, resident bedrooms and bathrooms, laundry room, garage, and outside courtyards, to assess compliance with Title 22 regulations. LPA Lee observed the facility was clean, odor-free, and in good repair. Resident bedrooms were properly furnished with appropriate bedding and lighting and were found to be sanitary. The fire extinguishers, smoke detectors, and carbon monoxide detectors were in good working condition. The exterior of the home was free of debris, and the emergency exit gate was functional and in good repair. The kitchen was clean and sanitary. LPA Lee observed adequate food supplies, including a seven-day supply of non-perishable food and a two-day supply of perishable food, both of which were accessible to residents. A review of records for Resident #1 (R1) indicated that R1 is both non-ambulatory and bedridden. This was confirmed through interviews with R1 and R1’s responsible party. However, it was discovered that R1 is currently housed in Bedroom #2, which does not have fire clearance for a bedridden resident. The facility is only approved to house a bedridden resident in Bedroom #3.

Continued LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Pang Lee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ALL OUR LOVE SENIOR HOME, INC
FACILITY NUMBER: 342701533
VISIT DATE: 06/18/2025
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LPA Lee reviewed two resident files and it was found to be complete. A medication review was also conducted for Resident #2 (R2). It was unclear what medications are currently prescribed to R2. Based on R2's LIC 602 Physicians Report, R2 needs assistance in these areas; however, R2 is able to manage own medications , administer own medications, and store their own medications. It was also learned that R2 stores part of R2's medications in their room, while the facility stores the remaining medications in a locked cabinet. Clarification is still needed regarding R2’s prescribed medications. LPA Lee will follow-up on this on complaint control # 27-AS-20250616145518.

As a result of this post-licensing visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. The facility was also assess an immediate civil penalty. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, LIC 421 IM and Appeals rights were provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Pang Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/18/2025 04:58 PM - It Cannot Be Edited


Created By: Pang Lee On 06/18/2025 at 04:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ALL OUR LOVE SENIOR HOME, INC
FACILITY NUMBER: 342701533

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/20/2025
Section Cited
CCR
87202(a)(2)

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87202 Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.
(2) Bedridden persons

This requirement was not met as evidenced by:
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Administrator Erica stated that she will talk to R1 and R1’s responsible party to have R1 move to the fire cleared bedroom #3 for bedridden resident. POC will be cleared by visit. Administrator will review the regulation cited and email LPA Lee a statement of acknowledgement of understanding the regulation by POC date of 06/20/25 end of day 5:00 PM
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A review of records for Resident #1 (R1) indicated that R1 is both non-ambulatory and bedridden. This was confirmed through interviews with R1 and R1’s responsible party. However, it was discovered that R1 is currently housed in Bedroom #2, which does not have fire clearance for a bedridden resident. The facility is only approved to house a bedridden resident in Bedroom #3.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM MANAGER:
Pang Lee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2025


LIC809 (FAS) - (06/04)
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