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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701316
Report Date: 01/15/2025
Date Signed: 01/15/2025 11:53:55 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/15/2025 11:53 AM - 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:BROWN LOVING CARE LLCFACILITY NUMBER:
502701316
ADMINISTRATOR/
DIRECTOR:		MORENO DE BROWN, LAURAFACILITY TYPE:
740
ADDRESS:6616 GRAYBARK LANETELEPHONE:
(209) 883-7099
CITY:HUGHSONSTATE: CAZIP CODE:
95326
CAPACITY: 6CENSUS: 5DATE:
01/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Nicole Rivera/ Hilda VelazquezTIME VISIT/
INSPECTION COMPLETED:
11:51 AM
NARRATIVE
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Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual visit on this date. LPA met with Nicole Rivera/ Hilda Velazquez and explained the purpose of the visit. LPA was later joined by L. Brown and Diana Brown

The facility is a single story structure with wheelchair accessibility. LPA observed all required signage, including license to be prominently posted. LPA toured the facility indoors and outdoors including but not limited to dining room, living room, kitchen, covered garage/ smoking area, 3 bathrooms, 2 bedrooms and backyard. The facility is licensed for 6 clients. (Advisories given)

Hot water temperature was measured at 125.8 degrees Fahrenheit in resident's bathroom sink, which is not within the required range of 105 to 120 degrees. Fire extinguishers are current and in compliance with fire safety. Carbon dioxide monitor present. Smoke detector are operational . LPA reviewed 5 resident and 2 staff files, including criminal record clearances.

All staff today are associated to the facility. First aid kit was checked and is complete.
An exit interview was conducted and a report was left with the facility with appeal rights.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/15/2025 11:53 AM - It Cannot Be Edited


Created By: Albert Johnson On 01/15/2025 at 10:42 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BROWN LOVING CARE LLC
FACILITY NUMBER: 502701316

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/16/2025
Section Cited
CCR
87303(e)(2)

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(e) Water supplies and plumbing fixtures shall be maintained as follows:
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).
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Adminstrator shall adjust the hot water temperature. Once the water is at the regulation temperature the administrator shall create a log and record the temperature twice a day
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Based on LPA observation the licensee did not comply with the section cited above in 87303(e)(3). LPA observed bathrooms hot water measured above 120 degrees F. (125.8) which poses an immediate health, safety or personal rights risk to persons in care.
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 (AM & PM) for three days to reflect the temperature is within parameters. The record will be submitted to the department at the conclusion of the three days

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Albert Johnson
LICENSING EVALUATOR SIGNATURE:
DATE: 01/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/15/2025


LIC809 (FAS) - (06/04)
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