306001351-8-6-2026-22-AS-RMRT-DWPTMV-20260806145147

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306001351
Report Date: 08/06/2026
Date Signed: 08/06/2026 02:51:54 PM

Document Has Been Signed on 08/06/2026 02:51 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	TESS LOVING HOME II		FACILITY NUMBER:	306001351
ADMINISTRATOR/ DIRECTOR:	MARITES VILLANUEVA		FACILITY TYPE:	740
ADDRESS:	2785 E. DIANA AVE.		TELEPHONE:	(714) 630-0999
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92806
CAPACITY: 6		CENSUS: 4	DATE:	08/06/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Marites Villanueva, Administrator		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

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) Rose Ruppert made an unannounced visit to the facility to conduct an Annual Required Evaluation. LPA was greeted and granted entry by staff at 12:30pm. LPA met with Administrator Marites "Tess" Villanueva and explained the purpose of the visit. The facility is a single story, five bedroom, two bathroom residential home with an approved fire clearance of six non-ambulatory residents with a hospice waiver for six residents. Currently there are four residents in care and none of the residents receive hospice services. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. Staff trainings were current and documented. The administrator has a current administrator's certificate which expires on December 12, 2027. The facility has liability insurance and the Emergency Disaster Plan was reviewed and initialed. Licensing fees are current and the See Something, Say Something and Long Term Care Ombudsman posters were posted in a prominent area. During the visit, LPA toured the facility and inspected carbon monoxide and smoke detectors. The carbon monoxide and smoke detectors were operational. The facility was 73 degrees Fahrenheit and there were no odors detected. The fire extinguisher was charged and inspected on June 23, 2026. The facility's last fire and heat drill was conducted on July 10, 2026. LPA observed the sharps and knives were secured in a locked cabinet and chemicals were secured underneath the sink. The facility had two days of perishable food items and seven days of non perishable food items on site. A weekly food menu was observed on the refrigerator. All kitchen appliances and washer and dryer were in working order. (Continued on LIC 809-C)

Alisa Ortiz
RoseMarie Ruppert
	DATE: 08/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026

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: TESS LOVING HOME II	FACILITY NUMBER: 306001351
	VISIT DATE: 08/06/2026

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(Continued from LIC 809)

LPA toured resident bedrooms and observed residents had the required furnishings, and clean linens. LPA tested the hot water temperature in two of two resident bathrooms and the hot water temperature ranged from 114.2 to 114.4 degrees Fahrenheit. Bathrooms had grab bars and non-skid flooring and hygiene items were secured beneath the sink.

LPA toured the detached garage which is used for storage and walked the exterior of the property. There is ample space for outdoor activities and there were no hazards or obstructions in pathways. A shaded seating area was available and the exterior gate is self-latching. LPA observed emergency supplies and water for the residents.

LPA attempted to interview two of four residents. Two residents were sleeping after lunch, and two residents were unable to communicate but appeared dressed and clean. LPA interviewed two of two staff members regarding care provided. LPA observed secured medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid kit had the required elements and the Administrator purchased a First Aid Manual for the facility.

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Marites Villanueva, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026

LIC809 (FAS) - (06/04)

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