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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604823
Report Date: 10/09/2024
Date Signed: 10/09/2024 04:24:36 PM

Document Has Been Signed on 10/09/2024 04:24 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LOVING HEART ASSISTED LIVING LLCFACILITY NUMBER:
374604823
ADMINISTRATOR/
DIRECTOR:
RICHARDSON, HENRYFACILITY TYPE:
740
ADDRESS:4430 LOWELL STTELEPHONE:
(909) 645-4998
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: 6CENSUS: 2DATE:
10/09/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Arceli Songco AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA), Amy Domingo conducted an announced Post Licensing visit. LPA was greeted and allowed entry into the facility by staff member Victoria Andrade and Arceli Songco, Administrator arrived shortly after LPA arrival. LPA stated the purpose of today’s visit, to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22. The facility is licensed to serve six (6) Non-Ambulatory elderly residents; Ages 60 and above.

A tour of the facility was conducted inside and out with the Administrator. LPA observed sufficient supply of linens and hygiene products. The facility temperature was 75 degrees at the time of the visit. Hot water temperature measured at 114 degrees Fahrenheit. Disinfectants, cleaning solutions, and poisons were inaccessible to residents during the time of the visit. All of the resident rooms were equipped with the required furnishings. Resident bathrooms were observed to be sanitary and equipped with the required supplies. Per the Licensee, there are no weapons and/or ammunition on the premises. No bodies of water were observed. Caregivers have current First Aid/CPR training and have criminal background clearances. The facility was stocked with a 2 day supply of perishable and a 7 day supply of nonperishable food items. The food was observed properly stored. Medications are centrally stored in a locked cabinet and administered according to the label instructions. LPA observed required postings in a prominent place in the facility.

Based on today's visit, there were no deficiencies observed at this time in the areas evaluated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) was provided to Areceli Songco, Administrator, whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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