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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001456
Report Date: 06/30/2026
Date Signed: 06/30/2026 12:26:37 PM

Document Has Been Signed on 06/30/2026 12:26 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:K'S LOVING CARE IN YORBA LINDAFACILITY NUMBER:
306001456
ADMINISTRATOR/
DIRECTOR:		KEBEDE REGATFACILITY TYPE:
740
ADDRESS:19192 MC CARTHY LANETELEPHONE:
(714) 693-9156
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 6CENSUS: 5DATE:
06/30/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:01 AM
MET WITH:Regat KebedeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On Tuesday June 30, 2026 Licensing Program Analyst (LPA) Nancy Guillen conducted an unannounced Case Management- Deficiencies visit. The visit is being conducted in conjunction with complaint control number 22-AS-20260627090909. Administrator(AD) Regat Kebede was notified via telephone and later arrived to assist with the inspection.

During the investigation into the complaint, LPA toured the facility, requested documentation and did a health and safety check on the residents in care.

At approximately 8:30am, LPA observed the medication cabinet to be unlocked and accessible to residents in care. LPA asked Administrator to lock the cabinet. AD called Staff 1(S1) to lock the medication cabinet. S1 proceeded to look for keys. While S1 looked for the keys LPA asked S1 how long the cabinet had been unlocked for. S1 stated it was unlocked for "about 20 minutes." The key was found and the medication closet was locked with LPA present.

At approximately 8:40 am, LPA asked to see the staff room. LPA observed an individual (ID) siting in the room with the lights off. LPA asked the individual for their name and AD responded stating this individual was only there for an interview. LPA asked to speak to the individual privately. During the interview the individual stated, they had been at the facility since 6:30 am and are scheduled to leave at 6pm. They also stated the visit for today was to "do the job and they see how I do." LPA verified on Guardian that the application is currently pending. The individual was asked by the AD to leave the facility and ID left immediately after.

Continued on LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: Nancy Guillen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2026
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: K'S LOVING CARE IN YORBA LINDA
FACILITY NUMBER: 306001456
VISIT DATE: 06/30/2026
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At approximately 8:46 am LPA observed WD-40, Lysol Disinfectant Spray, Probiotic Plus & Cranberry and medication Escitalopram in an unlocked staff room. LPA asked AD to lock the door, however the door does not have the capability to lock. LPA then had AD remove the items from the room.

At approximately 8:49am, LPA observed Saline Solution, Pain Relieving Cleansing Spray and medication Latanoprost in bedroom for Resident 1. LPA asked AD to remove the items. Items were removed and placed in the locked medication closet.

Based on the information gathered during the visit, deficiencies are being cited on the attached LIC809-D page. An exit interview was conducted with Administrator Regat Kebede. A copy of this report and appeal rights were left at the facility at time of visit.
NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: Nancy Guillen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 06/30/2026 12:26 PM - It Cannot Be Edited


Created By: Nancy Guillen On 06/30/2026 at 10:47 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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: K'S LOVING CARE IN YORBA LINDA
FACILITY NUMBER: 306001456

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/01/2026
Section Cited
CCR
87465(h)(2)

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87465(h) ...(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by:
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Licensee immediately had the medication closet locked. Licensee will ensure they understand the regulation and send LPA a signed statement of understanding via email by the POC due date.Licensee to conduct an in-service training with staff for regulation 87465(h)(2) and send to LPA byJuly 28, 2026.
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Based on observation and interview, the licensee did not comply with the section cited above due to centrally stored medication being unlocked which poses and immediate health safety and personal rights risk to persons in care.
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Type A
07/01/2026
Section Cited
CCR87309(a)

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87309(a)Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, ... , and other similar items... are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by:
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Licensee immediately removed all hazardous items. Licensee will ensure they understand the regulation and send LPA a signed statement of understanding via email by the POC due date. Licensee to conduct an in-service training with staff for regulation 87309(a) and send to LPA byJuly 28, 2026.
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Based on observation and interview, the licensee did not comply with the section cited above due to hazardous substances being found in unlocked staff room and resident room which poses and immediate health safety and personal rights risk to persons in care.
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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.
Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM MANAGER:
Nancy Guillen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/30/2026 12:26 PM - It Cannot Be Edited


Created By: Nancy Guillen On 06/30/2026 at 11:26 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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: K'S LOVING CARE IN YORBA LINDA
FACILITY NUMBER: 306001456

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/01/2026
Section Cited
CCR
87355(e)(2)

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87355(e)(2) All individuals subject to a criminal record review... shall prior to working... in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department ... This requirement is not met by evidence by:
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Licensee sent individual (ID) home. Licensee will ensure they understand the regulation and send LPA via email a signed statement of understanding by the POC due date. LPA informed licensee individual may not return until application is cleared.
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Based on observation, interview, and record review the licensee did not comply with the section cited above in one of three staff present, which poses and immediate health safety and personal rights risk to persons in care.
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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.
Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM MANAGER:
Nancy Guillen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
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