306000543-4-23-2025-22-AS-JHAY-DFZMNJ-20250423094538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306000543
Report Date: 04/23/2025
Date Signed: 04/23/2025 09:46:09 AM

Document Has Been Signed on 04/23/2025 09:46 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	HELLEN LOVING HOME CARE		FACILITY NUMBER:	306000543
ADMINISTRATOR/ DIRECTOR:	ELENA GHERMAN		FACILITY TYPE:	740
ADDRESS:	10592 BELL STREET		TELEPHONE:	(714) 396-4522
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/23/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	07:40 AM
MET WITH:	Elena Gherman		TIME VISIT/ INSPECTION COMPLETED:	10:00 AM

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	Licensing Program Analyst (LPA) Jerome Haley arrived at the facility for the purpose of conducting the required Annual Required Inspection. LPA Haley was greeted at the door and explained the reason for the visit. The facility was licensed April 6, 1998, and there have never been any residents in care. The licensee wishes to remain licensed, and all licensing fees are current; however, Licensee Gherman does not plan on admitting any residents for at least another year. There are two structures on the property and the facility will operate in the back house. The front house is where the licensee resides with her husband. The structure in the back of the property where the facility will operate, is a one level structure with three bedrooms and two bathrooms. Bedrooms have the necessary elements including night stands, lamps, storage space, beds and appropriate linens. Resident bathrooms have grab bars, nonskid mats, toilets, and wash basins. One bedroom is currently being used by the licensee as a storage space for some of the licensee’s personal items. The bathrooms had grab bars, nonskid mats, and a toilet and wash basin. One of the shower areas is also being used by the licensee as a storage space. Although there are no residents, LPA toured the exterior portion of the facility to make observations. There’s adequate space available. No bodies of water were observed. A table and chairs were observed. During the inspection, several items/objects were observed in all areas of the property.

Lourdes Montoya	TELEPHONE: (714) 703-2870
Jerome Haley	TELEPHONE: 714-703-2840
	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HELLEN LOVING HOME CARE	FACILITY NUMBER: 306000543
	VISIT DATE: 04/23/2025

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The licensee was advised there needs to be significant improvement/changes made before a resident can be admitted to the facility.

The licensee understands and was completely aware of everything that needs to be done. The licensee has a fire extinguisher, first aid kit, and smoke detectors tested operational. Contact information was verified and a number to a land line was provided although the licensee preferred means of contact is by cell phone.

No deficiencies are being cited, and no advisories will be issued as a result of today’s visit. An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC809 (FAS) - (06/04)

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