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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134601903
Report Date: 02/13/2024
Date Signed: 02/13/2024 02:06:31 PM

Document Has Been Signed on 02/13/2024 02:06 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:TENDER LOVING CARE IIFACILITY NUMBER:
134601903
ADMINISTRATOR:HUGRSTINE FOSTERFACILITY TYPE:
735
ADDRESS:286 W DUARTE STTELEPHONE:
(760) 344-2566
CITY:BRAWLEYSTATE: CAZIP CODE:
92227
CAPACITY: 4CENSUS: 3DATE:
02/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Hugrstine FosterTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced required annual inspection. LPA introduced herself and was granted entry into the facility by Annazette Wright, Staff, to whom LPA disclosed the purpose of the visit. Licensee, Hugrstine Foster, was contacted via telephone and arrived a short time later.

According to the facility’s license, the facility has a maximum capacity of four (4) clients, all of whom must be ambulatory. There are a total of three (3) clients currently residing in the facility.

LPA, accompanied by the licensee and staff, toured the interior and exterior of the facility. The facility was clean and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors and toilets were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s internal temperature was 75 degrees Fahrenheit. Hot water temperature at sink in bathroom used by clients measured at 112.5 degrees Fahrenheit.

Refrigerator and freezer were operational. There was at least 2 days of perishable food and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. There was a fireplace that was appropriately screened. Medications were labeled, as required, and stored in a locked cabinet.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: TENDER LOVING CARE II
FACILITY NUMBER: 134601903
VISIT DATE: 02/13/2024
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No pools or bodies of water were observed on the premises. According to the licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, and facility telephone were in working order. Licensing postings were observed in a visible area of the facility.

LPA interviewed staff and reviewed records/files. Staff and client files contained required documents. Confidential records were stored in a locked cabinet.

No deficiencies were cited during today's annual inspection.

An exit interview was conducted with Hugrstine Foster, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC809 (FAS) - (06/04)
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