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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880877
Report Date: 02/05/2026
Date Signed: 02/05/2026 03:24:36 PM

Document Has Been Signed on 02/05/2026 03:24 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BIG HEARTS LOMAS VERDES, INC.FACILITY NUMBER:
361880877
ADMINISTRATOR/
DIRECTOR:		SCHAEFER, EVELINAFACILITY TYPE:
735
ADDRESS:25586 LOMAS VERDES STTELEPHONE:
(909) 328-2009
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY: 4CENSUS: 4DATE:
02/05/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Caregiver, Alice MundeTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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At 12:05 pm on February 5, 2026 (02/05/26), Licensing Program Analysts (LPAs) Andrew Martinez and Sarina Ramirez made an unannounced visit to complete the required annual inspection to the facility. LPAs met with Caregiver, Alice Munde, and discussed the purpose of the visit.

The facility is an Adult Residential Facility (ARF); level six (6). The facility is an Inland Regional Center (IRC) certified vendor with a license capacity of four (4) clients and a current census of four (4). At the time of visit, there were two (2) additional staff, and one (1) client present, with the remaining clients attending Adult Day Program (ADP). LPAs were accompanied by Caregiver, Alice Munde, who conducted an overall inspection of the facility, which included, but was not limited to, the following:

Physical Plant & Operation: The facility is a single-story, three (3)-bedroom, 2-bathroom home, with a kitchen, pantry, dining and living rooms, front and backyards, attached garage, 1 fireplace, and 1 swimming pool. Indoor and outdoor passageways are free of obstruction. Indoor and outdoor activity areas are sufficient for clients in care. There are no firearms or ammunition stored. LPAs observed the facility maintained a comfortable temperature of 74.0 degrees Fahrenheit (°F). LPAs inspected client bedrooms which are all equipped with required furniture such as mattresses, nightstands, storage space, and sufficient lighting. All bathrooms were clean and equipped with a wash basin, toilet, and shower all in operable condition. LPAs measured the hot water temperature delivered to plumbing fixtures in both bathrooms to be at 102.2°F and 107.3°F. The facility is equipped with laundry equipment, telephone service, 1 fire extinguisher, smoke alarms, and carbon monoxide detectors which were observed and/or tested and found in compliance.
NAME OF LICENSING PROGRAM MANAGER: Karen Clemons
NAME OF LICENSING PROGRAM ANALYST: Andrew Martinez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2026
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: BIG HEARTS LOMAS VERDES, INC.
FACILITY NUMBER: 361880877
VISIT DATE: 02/05/2026
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Kitchen/Pantry: All appliances are operable and in good working condition. The kitchen is free of dirt and debris. Knives and sharp objects are stored in a locked drawer, and keys are kept with staff. LPAs observed sufficient food supply for the number of clients in care with seven (7) days of nonperishable food and 2 days of perishable food.

Dining Room/Living room/Hallway: LPAs observed dining room to have adequate lighting and a large table with adequate seating for staff and clients in care. LPAs observed the living room contains a television, seating area, side table and space used for relaxation and visitation area for friends and/or relatives. The facility’s fireplace is in the living room and is kept inaccessible to clients in care. Hallway is kept clean, equipped with adequate lighting, and spaced accessible for wheelchairs and walkers. The hallway contains linen storage with supply for all clients in care.

Garage/Storage: LPAs confirmed with Caregiver the access doors to the attached garage are always locked and keys/garage code are provided only to staff. The garage is equipped with shelving and storage cabinets which contain client’s belongings, holiday decor, additional cleaning supplies, paper goods, and tools, as well as personal protective equipment (PPE) such as gloves, and hand sanitizer. The garage also contains an additional chest freezer and water heater.

Outdoor/Yard Areas: LPAs observed the front yard to be well kept and gardening maintained. The backyard area contains a patio with patio furniture for seating, shaded by a canopy. All outdoor activity areas are also well kept, passageways are clear and free of debris, and all window screens look clean. The facility has 1 swimming pool with no water, inaccessible to clients behind a chain link fence kept always locked.

Facility Files: LPAs reviewed facility files such as the Infection Control and Emergency Disaster Plans, both signed by Licensee for review on February 5, 2026 (02/05/26). Licensee confirmed fire and disaster drills are conducted monthly as per the Emergency Disaster Drill Log. LPAs reviewed personnel files such as the Personnel Report and Personnel Record to confirm the facility has sufficient staff coverage for care of clients 24 hours a day, 7 days a week. LPAs observed the proper postings of emergency disaster plan and telephone numbers, facility license, weekly menu, and Administrator's Certificate posted in a common area.

NAME OF LICENSING PROGRAM MANAGER: Karen Clemons
NAME OF LICENSING PROGRAM ANALYST: Andrew Martinez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
LIC809 (FAS) - (06/04)
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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: BIG HEARTS LOMAS VERDES, INC.
FACILITY NUMBER: 361880877
VISIT DATE: 02/05/2026
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Record Review: LPAs reviewed 4 client files for Admission Agreement Guide, Physician's Report, Individual Program Plan (IPP), P&I money, and Centrally Stored Medication and Destruction Records. Medications were audited and appeared to be dispensed appropriately by staff members. LPAs reviewed 2 staff files for Criminal Record Clearance, Health Screening Report, TB test results, CPR and First Aid certification, and training logs. LPAs observed that 4 of 4 clients and 2 of 2 staff files were well maintained and complete.

Medical Related Services: Client’s medications are labeled and locked in centrally stored medication cabinet in the staff room.

During inspection, LPAs observed a dark brown, 6-drawer dresser located in Client #1 (C1) bedroom, to be broken and disrepair. LPAs also observed the facility's backyard fence to be broken in multiple sections that could pose a risk to the health and safety of clients in care. Additionally, LPAs observed the facility’s side gate on west side of the structure was left open. Caregiver immediately mitigated the finding by closing the gate and ensuring it was latched properly. Based on the observations made during today’s visit, 2 Type B deficiencies are being cited in accordance with the California Code of Regulations (CCR), Title 22, Division 6.

An exit interview was conducted, and Plans of Corrections were developed and reviewed with Licensee. A copy of this report LIC 809, LIC 809C, LIC 809D, and letter of Appeal Rights were provided to and discussed with Caregiver, Alice Munde, whose signature on this form confirms receipt of stated documents. Please see LIC 809D for citations related to the deficiencies observed during this inspection.
NAME OF LICENSING PROGRAM MANAGER: Karen Clemons
NAME OF LICENSING PROGRAM ANALYST: Andrew Martinez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/05/2026 03:24 PM - It Cannot Be Edited


Created By: Andrew Martinez On 02/05/2026 at 02:46 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: BIG HEARTS LOMAS VERDES, INC.
FACILITY NUMBER: 361880877

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80077.3(a)
Care for Clients who Lack Hazard Awareness or Impluse Control
(a) If a client requires protective supervision because of running/wandering away, supervision may be enhanced by fencing yards, using self-closing latches and gates, and installing operational bells, buzzers, or other auditory devices on exterior doors to alert staff when the door is opened. The fencing and devices must not substitute for appropriate staffing.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as the side gate on west side of facility was identified as unlatched and open which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/19/2026
Plan of Correction
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Licensee will review regulation with facility staff and provide training to ensure compliance. Licensee will provide proof of completed training with a copy of training log containing signatures of staff to LPAs via email by POC due date.
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above by not maintaining a safe backyard fence and client's dresser in good repair at all time which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/19/2026
Plan of Correction
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Licensee stated they have a repairperson coming Saturday, February 07, 2026, to repair backyard fence, and will be switching out client's dresser to another chest of drawers that is compatible for client to be less likely to break. Licensee stated they will provide invoice of fence repair(s) along with photographic evidence of completed repair(s) and dresser replacement via email to LPAs by POC due date.
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:
Andrew Martinez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2026


LIC809 (FAS) - (06/04)
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