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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880919
Report Date: 01/06/2026
Date Signed: 01/06/2026 11:16:37 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/29/2025 and conducted by Evaluator Becky Mann
COMPLAINT CONTROL NUMBER: 56-AS-20251229151915
FACILITY NAME:LOVE 2 CARE HOMESFACILITY NUMBER:
361880919
ADMINISTRATOR:JACKSON, TERRIFACILITY TYPE:
740
ADDRESS:19432 US HIGHWAY 18TELEPHONE:
(760) 297-6277
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:6CENSUS: 6DATE:
01/06/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rosalyn Walker, CaregiverTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff did not provide resident's authorized representative with resident's records
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA Mann met with Rosalyn Walker, Caregiver and explained the purpose of today's visit. The investigation consisted of LPA observations, pertinent document reviews, and interviews with staff.

The allegation that staff did not provide resident's authorized representative with resident's records. LPA Mann interviewed Staff #1 (S1) and they stated that the facility did not provide resident's authorized representative with resident's records.

Based on LPA observations, interviews and records review, the above allegation is Substantiated. A determination that the complaint is substantiated means that the allegation is/are valid because the preponderance of the evidence standard has been met.
An exit interview was conducted where this report was discussed and provided to Rosalyn Walker, Caregiver.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 56-AS-20251229151915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: LOVE 2 CARE HOMES
FACILITY NUMBER: 361880919
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2026
Section Cited
CCR
87468.2(a)(19)
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87468.2(a)(19)‘residents in privately operated residential care facilities for the elderly shall have all .. personal rights:’ ... ‘(19) To have prompt access to review all of their records ... Photocopied records shall be provided within two (2) business days... This requirement is not met as evidenced by:
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Administrator will submit a Statement of Understanding to LPA by Plan of Correction (POC) due date
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Based on LPA observations, interviews, and record reviews, staff did not provide resident's authorized representative with resident's records which poses a personal rights risk to residents 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.
SUPERVISOR'S NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2