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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881142
Report Date: 01/17/2024
Date Signed: 01/17/2024 01:27:15 PM


Document Has Been Signed on 01/17/2024 01:27 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:TWIN HEARTS SENIOR CARE, LLCFACILITY NUMBER:
331881142
ADMINISTRATOR:MANGENTE, KRISTINE A.FACILITY TYPE:
740
ADDRESS:995 BOUQUET CIR.TELEPHONE:
(951) 736-6925
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:6CENSUS: 5DATE:
01/17/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Staff Frederic ManuelTIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced case management visit during complaint control number 56-AS-20231122112404. LPA met with staff Frederic Manuel and explained the purpose of today’s visit.

During a prior visit on 11/28/2023, LPA observed R1 doorknob not working, the doorknob did not open and close properly. During today’s visit, LPA observed that R1 doorknob has not been fixed. S1 admitted they did not fix R1 doorknob because they have been too busy. A civil penalty in the amount of $4,200 will be issued for failure to correct the violation within a specified length of time that result in a civil penalty.

In addition, during a prior visit on 11/28/2023, LPA observed cleaning solutions under the sink without a lock. During today’s visit LPA observed a bottle of cleaning solution under the sink without a lock. LPA requested S2 to remove the bottle of cleaning solution immediately. S2 stated they did not have the keys to lock the cleaning solution, S2 also stated they will request keys from the Administrator. A civil penalty in the amount of $4,900 will be issued for failure to correct the violation within a specified length of time that result in a civil penalty.


Based on today's observation, two (2) civil penalties in the amount of $4,200 and $4,900 dollars will be issued for failure to correct the two (2) violations within a specified length of time that result in a civil penalty. The facility will be issued two (2) civil penalties per Title 22, Division 6, of the California Code of Regulations,

An exit interview was conducted, and this report (LIC809) was discussed and provided to staff Frederic Manuel along with a copy of the two (2) LIC421FC and along with the appeal rights.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2024
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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