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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880584
Report Date: 04/09/2026
Date Signed: 04/09/2026 12:34:57 PM

Document Has Been Signed on 04/09/2026 12:34 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:NAVIN CAREFACILITY NUMBER:
361880584
ADMINISTRATOR/
DIRECTOR:		MARTIN, USHAFACILITY TYPE:
735
ADDRESS:12631 ALGONQUIN RDTELEPHONE:
(760) 240-5161
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 5CENSUS: 0DATE:
04/09/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Usha MartinTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
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On 04/09/2026, Licensing Program Analyst (LPA), Magda Malcore met with Licensee, Usha Martin, and conducted a case management visit. The purpose of the visit was to issue deficiencies following a department investigation of the physical abuse of client #1 (C1) and client #2 (C2).

On or around October 3, 2022, the Department received a report which indicated that staff #1 (S1) and staff #2 (S2) were arrested for physical abuse of C1. The Department investigation consisted of review of facility and other records, observations, and interviews with pertinent individuals.

Investigation revealed that on October 1, 2022, local law enforcement were dispatched for service to the facility. Shortly thereafter, an arrest warrant was issued for S1 and S2 for abuse of a dependent adult. Information received during the investigation revealed that on or around September 2022, C1 was taken to the ground (floor) and hit multiple times by S2, with S1 present. As a result, C1 was bleeding from multiple areas on face, and sustained a swollen eye. C1 did not receive medical services for injuries.

The Department was also informed that S1 and S2, on multiple occasions, would yell, slap, and/or hit C1 and C2. In addition, S1 made a statement to law enforcement that sometimes the clients attempt to hit staff and the natural response is to hit client back.

NAME OF LICENSING PROGRAM MANAGER: Karen Clemons
NAME OF LICENSING PROGRAM ANALYST: Magda Malcore
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2026
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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: NAVIN CARE
FACILITY NUMBER: 361880584
VISIT DATE: 04/09/2026
NARRATIVE
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 When further questioned by law enforcement, S1 admitted to this incident occurring sometimes. Law enforcement asked S1 how often it occurs when a client hits a staff member and the staff member hits them back. S1 replied, “of course, every day". When asked when the last time staff hit a client in the home, S1 immediately recanted previous statement and stated that staff does not hit the clients. In addition, S1 admitted to disciplining clients. Specifically, S1 stated that clients are rewarded for good behavior with going to restaurants; those who do not follow the rules and need discipline, S1 will bring them food instead of taking them to the restaurant.

Based upon information received, there is preponderance of evidence to support multiple personal rights violations. Deficiencies are being issued in accordance with Title 22, Division 6, of the California Code of Regulations. An immediate civil penalty in the amount of $500 is also being assessed today. An additional civil penalty may be assessed by the Health and Safety Code 1548.

An exit interview was conducted, and a copy of this report was provided to the Licensee at the conclusion of the visit. Appeal rights were provided to the Licensee and signature on this report acknowledges receipt of the appeal rights.

NAME OF LICENSING PROGRAM MANAGER: Karen Clemons
NAME OF LICENSING PROGRAM ANALYST: Magda Malcore
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/24/2026 02:01 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/24/2026 08:08 AM


Created By: Magda Malcore On 04/09/2026 at 11:51 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: NAVIN CARE
FACILITY NUMBER: 361880584

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/23/2026
Section Cited
CCR
80072(a)(3)

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(a)Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature…This requirement is not met as evidenced by:
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License has agreed to retraining by an outside vendor on client personal rights. Proof of training shall be provided to the licensing agency by POC due date.
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On or around September 2022, S2 physically abused C1, with S1 present. This resulted in C1 sustaining injuries. In addition, while C1 and C2 resided in facility, S1 and S2, on multiple occasions, would yell, slap, and/or hit C1 and C2; which posed an immediate health, safety, and personal rights risk to persons in care.
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Type A
04/17/2026
Section Cited
CCR80072(a)(9)

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(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(9)To receive or reject medical care, or health-related services...This requirement was not met as evidenced by:
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License has agreed to retraining by an outside vendor on client personal rights. Proof of training shall be provided to the licensing agency by POC due date.
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On or around September 2022, C1 was bleeding from face and did not receive care or services; which posed an immediate health, safety, and personal rights risks 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.
Karen Clemons
NAME OF LICENSING PROGRAM MANAGER:
Magda Malcore
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2026


LIC809 (FAS) - (06/04)
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