335530092-4-13-2026-56-AS-HROS-DT4LG5-20260413084410

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 335530092
Report Date: 04/10/2026
Date Signed: 04/13/2026 08:47:39 AM

Document Has Been Signed on 04/13/2026 08:47 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	BEDFORD DIVINE HOME CARE INC		FACILITY NUMBER:	335530092
ADMINISTRATOR/ DIRECTOR:	NANA AKUA MENSAH BEDFORD		FACILITY TYPE:	735
ADDRESS:	29695 WOLF GLEN CT		TELEPHONE:	(951) 926-6673
CITY:	WINCHESTER	STATE: CA	ZIP CODE:	92596
CAPACITY: 4		CENSUS: 3	DATE:	04/10/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:50 PM
MET WITH:	Staff Michael Eduah		TIME VISIT/ INSPECTION COMPLETED:	03:40 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) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Staff Michael Eduah. Administrator Nana Bedford was notified of the visit via phone. The facility's license shows a maximum capacity of four (4) ambulatory clients. During today’s inspection there were three (3) clients in care. LPA with staff toured the interior and exterior of the facility and inspected each room. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. LPA observed Client #1 (C1)’s refrigerated medication was in the kitchen’s food refrigerator unlocked with client access. No pools or bodies of water exist on the premises. Per staff, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC-809C]

NAME OF LICENSING PROGRAM MANAGER: Efren Malagon
NAME OF LICENSING PROGRAM ANALYST: Hannah Rodgers
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BEDFORD DIVINE HOME CARE INC	FACILITY NUMBER: 335530092
	VISIT DATE: 04/10/2026

NARRATIVE

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LPA reviewed facility records. Review of facility records and interviews revealed that the facility did not conduct quarterly emergency drills. Review of client records revealed that Client #1 (C1) had a restricted health condition of insulin-dependent diabetes but did not have a written Restricted Health Condition Care Plan on file. Furthermore, C1 did not have the results for communicable tuberculosis on file. Review of C1’s cash ledger revealed that C1’s balance and actual cash in file were unequal. Review of staff files revealed that Staff #1-Staff #3 (S1-S3) did not have health screening reports on file.

Six (6) deficiencies were cited per California Code of Regulation, Title 22. A plan of correction was jointly formulated, and an exit interview was conducted with Staff Eduah to whom a copy of this report, LIC809-C, LIC809-D pages and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

NAME OF LICENSING PROGRAM MANAGER: Efren Malagon
NAME OF LICENSING PROGRAM ANALYST: Hannah Rodgers
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/13/2026 08:47 AM - It Cannot Be Edited

Created By: Hannah Rodgers On 04/10/2026 at 02:45 PM

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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BEDFORD DIVINE HOME CARE INC	FACILITY NUMBER: 335530092
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80075(k)(1)

Health-Related Services

(k) The following requirements shall apply to medications which are centrally stored: (1) Medication 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:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in that Client #1 (C1)'s medications were in the kitchen refrigerator unlocked and accessible to clients which poses an immediate health and safety risk to three (3) out of three (3) clients in care.
	POC Due Date: 04/11/2026
	Plan of Correction
1 2 3 4	Licensee agrees to obtain a lock box and make C1's medications inaccessible to clients and send proof to the Department by POC due date of 4/11/2026.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Efren Malagon
NAME OF LICENSING PROGRAM MANAGER:

	Hannah Rodgers
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

LIC809 (FAS) - (06/04)

Page: 4 of 7

Document Has Been Signed on 04/13/2026 08:47 AM - It Cannot Be Edited

Created By: Hannah Rodgers On 04/10/2026 at 02:45 PM

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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BEDFORD DIVINE HOME CARE INC	FACILITY NUMBER: 335530092
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80026(h)(1)

Safeguards for Cash Resources, Personal Property and Valuables

(h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following: (1) Records of clients' cash resources maintained as a drawing account, which shall include a current ledger accounting, with columns for income, disbursements and balance, for each client. Supporting receipts for purchases shall be filed in chronological order. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that Client #1 (C1)'s cash ledger was inaccurate which posed a potential health, safety or personal rights risk to one (1) out of three (3) clients in care.
	POC Due Date: 05/08/2026
	Plan of Correction
1 2 3 4	Licensee agrees to update C1's cash ledger and conduct training with staff on cash resources documentation and send proof to the Department by POC due date of 5/8/2026.

Type B

Section Cited

CCR

80066(a)(10)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (10) A health screening as specified in Section 80065(g). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above in Staff #1-Staff #3 (S1-S3) did not have a health screening report on file which poses a potential health and safety risk to three (3) out of three (3) clients in care.
	POC Due Date: 05/08/2026
	Plan of Correction
1 2 3 4	Licensee agrees to obtain health screening reports for S1-S3 and send proof to the Department by POC due date of 5/8/2026.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Efren Malagon
NAME OF LICENSING PROGRAM MANAGER:

	Hannah Rodgers
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/13/2026 08:47 AM - It Cannot Be Edited

Created By: Hannah Rodgers On 04/10/2026 at 02:45 PM

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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BEDFORD DIVINE HOME CARE INC	FACILITY NUMBER: 335530092
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80069(c)(1)

Client Medical Assessments

(c) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in Client #1 (C1) did not have the results of an examination for communicable tuberculosis on file which poses a potential health and safety to three (3) out of three (3) clients in care.
	POC Due Date: 05/08/2026
	Plan of Correction
1 2 3 4	Licensee agrees to obtain C1's communicable tuberculosis results and send proof to the Department by POC due date of 5/8/2026.

Type B

Section Cited

CCR

80092.2(a)

Restricted Health Condition Care Plan

(a) If the licensee of an ARF chooses to care for a client with a restricted health condition, as specified in Section 80092, the licensee shall develop and maintain, as part of the Needs and Services Plan, a written Restricted Health Condition Care Plan. The plan must include all of the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in Client #1 (C1) did not have a written Restricted Health Condition Care Plan on file for C1's restricted health condition which poses a potential health and safety risk to one (1) out of three (3) clients in care.
	POC Due Date: 05/08/2026
	Plan of Correction
1 2 3 4	Licensee agrees to obtain a written Restricted Health Condition Care Plan for C1 and submit proof to the Department by POC due date of 5/8/2026.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Efren Malagon
NAME OF LICENSING PROGRAM MANAGER:

	Hannah Rodgers
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

LIC809 (FAS) - (06/04)

Page: 6 of 7

Document Has Been Signed on 04/13/2026 08:47 AM - It Cannot Be Edited

Created By: Hannah Rodgers On 04/10/2026 at 02:45 PM

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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BEDFORD DIVINE HOME CARE INC	FACILITY NUMBER: 335530092
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1565(c)

Other Provisions

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of individuals served by the facility is not required during a drill. While a facility may provide an opportunity for individuals served by the facility to participate in a drill, it shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in that the facility did not conduct quarterly emergency drills which poses a potential health and safety risk to three (3) out of three (3) clients in care.
	POC Due Date: 05/08/2026
	Plan of Correction
1 2 3 4	Licensee agrees to conduct an emergency drill and send proof of drill to the Department by POC due date of 5/8/2026. Licensee agrees to conduct emergency drills quarterly.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Efren Malagon
NAME OF LICENSING PROGRAM MANAGER:

	Hannah Rodgers
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

LIC809 (FAS) - (06/04)

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