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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803912
Report Date: 07/06/2022
Date Signed: 07/06/2022 10:51:41 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/27/2022 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 21-AS-20220627104121
FACILITY NAME:A LOVING LIVING HOME CAREFACILITY NUMBER:
486803912
ADMINISTRATOR:LOVELYN HOJILLAFACILITY TYPE:
740
ADDRESS:224 LOCH LOMOND DRIVETELEPHONE:
(707) 469-9029
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:6CENSUS: 5DATE:
07/06/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Staff Member #2, Sylvia CabannilaTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Staff did not provide a safe and comfortable environment for residents in care
Staff did not provide adequate food service
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at A Loving Living Home Care for the purpose of conducting an additional tour of the facility, interviewing a staff member, a resident and delivering complaint findings. LPA was greeted at the door by Staff Member, Imelda Good and was granted access into the facility.

During the course of the investigation, LPA toured the facility on June 30, 2022 and July 6, 2022 and observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. Hot water temperature measured at 111 degrees in residents bathrooms on both tours of the facility conducted on said dates. LPA observed the kitchen counter to be clean and free of clutter on both dates. LPA observed inside the kitchen fridge and freezer during both tours and found on both dates that the food was properly stocked and stored with perishable and non-perishable foods. LPA conducted staff and resident interviews on said dates that yielded no concerns with the facility.

(Report continued on LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
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-20220627104121
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: A LOVING LIVING HOME CARE
FACILITY NUMBER: 486803912
VISIT DATE: 07/06/2022
NARRATIVE
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A finding that the complaint allegations of, Staff not providing a safe and comfortable environment for residents in care and Staff not providing adequate food service are unsubstantiated meaning 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, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted and a copy of this was report was signed and given to the Staff Member, Sylvia Cabnila.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2