<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005162
Report Date: 09/09/2021
Date Signed: 09/21/2021 08:53:10 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/03/2021 and conducted by Evaluator Victoria Brown
COMPLAINT CONTROL NUMBER: 27-AS-20210903091307
FACILITY NAME:LOVE AND DIVINE HOME CAREFACILITY NUMBER:
347005162
ADMINISTRATOR:SARCADI, DENISFACILITY TYPE:
740
ADDRESS:6525 GREENHAVEN DRIVETELEPHONE:
(916) 591-0801
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:6CENSUS: 2DATE:
09/09/2021
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Denis SarcadiTIME COMPLETED:
03:01 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has no supervision during evening hours
Facility has no staff to assist with medications
Facility failed to report resident fall
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS REPORT IS AMENDED TO COMPLETE THE 9099 APPROPRIATELY RATHER THAN VAGUELY. LICENSEE AGREED.

THIS REPORT IS TO DELIVER THE FINDINGS OF UNFOUNDED. During the investigation, it was discovered that the resident did not reside in this home at this facility number. Therefore the findings are deemed UNFOUNDED.
Unfounded
Estimated Days of Completion: 30
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2