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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880843
Report Date: 01/22/2025
Date Signed: 01/22/2025 11:51:18 AM

Document Has Been Signed on 01/22/2025 11:51 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:LOVING CAREFACILITY NUMBER:
331880843
ADMINISTRATOR/
DIRECTOR:		BUSBY, SYLVIAFACILITY TYPE:
740
ADDRESS:34038 TURTLE CREEK STREETTELEPHONE:
(951) 303-0393
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Alexander Busy, Caregiver TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 01/22/25 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a 1 year required visit. LPA was greeted and granted entry by Caregiver Alexander Busy and met with Licensee Sylvia Busby via telephone where LPA explained the purpose of the visit. At the time of the visit there was (1) staff and (0) residents present.

A tour of the physical plant was conducted, LPA observed the following:

The kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the approved capacity. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen cabinet, available only to authorized individuals. LPA observed area to be clean and the furniture was observed to be in good condition in the common areas as well as inside the resident bedrooms.

The home was observed to be clean and clutter free with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date.

The medications will be stored in a locked medication cabinet and will distributed according to physician orders. The first aid kit was complete.



Based on today's inspection no deficiencies were issued. An exit interview was conducted and a copy of this report was provided to Alexander Busby, Caregiver.
Tricia DanielsonTELEPHONE: (951) 202-5067
Javina GeorgeTELEPHONE: (951) 217-3970
DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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