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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701293
Report Date: 11/16/2023
Date Signed: 11/16/2023 01:58:54 PM

Document Has Been Signed on 11/16/2023 01:58 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:LORILIE'S CARING HEARTFACILITY NUMBER:
502701293
ADMINISTRATOR:MANALOTOFACILITY TYPE:
740
ADDRESS:3109 WATERBURY COURTTELEPHONE:
(408) 991-5883
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 6CENSUS: 3DATE:
11/16/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee/Administrator Jonathan Manaloto TIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a post-licensing inspection. LPA Jason Lund met with Licensee/Administrator Jonathan Manaloto and explained the reason for the visit. Census: 3

LPA Jason Lund & Licensee/Administrator Jonathan Manaloto inspected/toured the physical plant: Patio is shaded with sufficient furniture. The facility and all four bedrooms are equipped with sufficient furniture and lighting. Grab bars and non-skid mats are present in bathrooms. All common areas are free of hazards, clean and in good repair. The is a storage shed that is locked. There is a fire extinguisher present that was inspected on 2/1/2023. There are plenty of pots and pans to use for food preparation. Thermometers were observed in both the refrigerator as well as the freezer. LPA observed locked garage. There is a sufficient seven- day non-perishable and two- day perishable food supply. LPA observed locked garage doors, a laundry area (chemicals locked in cabinet), locked drawer for knives, and sharp objects inaccessible to residents. LPA observed auditory devices installed on all exit doors, LPA observed medication storage that is locked and secured and LPA observed activities available to residents. There was a fully stocked First Aid Kit. There are two fire and carbon monoxide detectors in the home. LPA Lund reviewed two staff & two residents files.

No deficiencies cited during today visit and report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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