336402596-6-3-2026-18-AS-JTOS-DUPSFR-20260603135045

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336402596
Report Date: 06/03/2026
Date Signed: 06/03/2026 01:51:01 PM

Document Has Been Signed on 06/03/2026 01:51 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	SLB INCORPORATED-BAMBI		FACILITY NUMBER:	336402596
ADMINISTRATOR/ DIRECTOR:	FORTAJADA, JAMIELAH		FACILITY TYPE:	735
ADDRESS:	13331 BAMBI COURT		TELEPHONE:	(951) 653-0604
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92553
CAPACITY: 6		CENSUS: 5	DATE:	06/03/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Administrator, Jeffrey Castillo		TIME VISIT/ INSPECTION COMPLETED:	02:00 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	On June 3, 2026, Licensing Program Analyst (LPA), Jarred Torres, arrived unannounced at the facility to initiate an investigation pertaining to an incident involving the death of an adult resident. LPA met with Administrator, Jeffrey Castillo, explained the purpose of the visit, and conducted a health & safety check in the facility. This case management visit consisted of collecting pertinent documentation and conducting staff interviews regarding the death of Resident #1 (R1) who passed away on May 28, 2026. LPA conducted separate interviews with Administrator (AR), Jeffrey Castillo, Caregiver #1 (C1), Sonny Lim, Caregiver #2 (C2), Eden Castillo, and Caregiver #3 (C3), Noel Castillo, to obtain additional information regarding the death of R1 and the events that led up to R1's death. AR stated that no official death certificate has been issued at this time, however, based on an interview with R1's responsible party, LPA was informed that they suspect the cause of death was cardiac arrest which lead to aspiration pneumonia. However, the coroner's report and death certificate are currently unavailable and the family does not have them yet. LPA advised AR to send a copy of the death certificate to the Community Care Licensing Division (Department) Riverside Regional Office as soon as it is available. During the record review, LPA observed that the facility followed the proper medical measures to assist R1. Furthermore, no indication of neglect or abuse was found or observed during this visit. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was discussed with and provided to Administrator, Jeffrey Castillo, whose signature on this form confirms receipt. Continued on LIC 809-C...

NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Jarred Torres
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026

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

FACILITY NAME: SLB INCORPORATED-BAMBI	FACILITY NUMBER: 336402596
	VISIT DATE: 06/03/2026

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*** Health and Safety Check ***

On June 3, 2026, Licensing Program Analyst (LPA), Jarred Torres, arrived unannounced at the facility to conduct a health and safety check. LPA met with Administrator, Jeffrey Castillo, explained the purpose of the visit, and toured the facility. All five clients were present in the facility and appeared to be healthy and receiving proper care. No immediate health or safety concerns were observed during this visit. LPA inspected the inside and outside of the facility, observed a three day supply of perishable foods, and seven day supply of non-perishable foods. The needs of the residents in care appear to be met during this visit.

An exit interview was conducted, and this report was discussed with and provided to Administrator, Jeffrey Castillo, whose signature on this form confirms receipt.

NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Jarred Torres
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026

LIC809 (FAS) - (06/04)

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