486803906-8-19-2025-21-AS-BMOS-DKQV87-20250820161215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803906
Report Date: 08/19/2025
Date Signed: 08/19/2025 09:58:17 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/30/2025 and conducted by Evaluator Star Stevenson

COMPLAINT CONTROL NUMBER: 21-AS-20250730085727

FACILITY NAME:	LUVINHOME,LLC		FACILITY NUMBER:	486803906
ADMINISTRATOR:	CAMERINO, ANNY K.		FACILITY TYPE:	740
ADDRESS:	974 SUFFOLK WAY		TELEPHONE:	(707) 999-8276
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	6	CENSUS: 5	DATE:	08/19/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Anny Camerino - Administrator		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not keeping facility clean, safe, sanitary and in good repair at all times.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At approximately 09:15, Licensing Program Analyst (LPA) Stevenson arrived unannounced to deliver findings for a Complaint Investigation regarding the above allegation and met staff member Mark Kho who called Administrator Anny Camerino who arrived at 9:45 AM. In addition, LPA conducted an additional private interview with client 2 (C2).

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. There was an allegation of “Staff are not keeping facility clean, safe, sanitary and in good repair at all times.” Complaint alleged the facility was in dirty condition including urine odors, a few dead cockroaches, fecal streaking throughout the hallway floor and dirty refrigerator”

During visit on 08/05/2025, LPA conducted a walkthrough of the facility bathrooms and bedrooms and inspected refrigerators. LPA observed the following: home was without urine or other odors, bathrooms were clean, hallway floors and walls were clean. No evidence of cockroaches was seen. LPA noted evidence minor uncleaned and dried spills of sauce or other condiments in main kitchen facility fridge (photos take). LPA did not observe any broken appliances or other items available to residents. LPA observed cleaning products available for staff use.
Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

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

Control Number 21-AS-20250730085727

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LUVINHOME,LLC	FACILITY NUMBER: 486803906
	VISIT DATE: 08/19/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC9099
Administrator noted that one client has made it a habit of cleaning continually since their admission and it may be that the facility was cleaner during my initial investigation than when the original complaint was made.
Based on observations made, interviews conducted and records reviewed , this allegation is Unsubstantiated. A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report discussed and provided to Administrator Anny Camerino. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2