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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530127
Report Date: 12/31/2024
Date Signed: 12/31/2024 10:02:39 AM

Document Has Been Signed on 12/31/2024 10:02 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:CHRISTIAN'S LOVE ELDERLY CARE FACILITY, LLCFACILITY NUMBER:
365530127
ADMINISTRATOR/
DIRECTOR:
UCHE, JULIAFACILITY TYPE:
740
ADDRESS:15336 LASSEN DRTELEPHONE:
(760) 334-8281
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY: 6CENSUS: 0DATE:
12/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:54 AM
MET WITH:Julia Uche- LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Licensee, Julia Uche and introduced self and stated purpose of the visit. LPA was informed that there are no residents in care.

The facility has 3 resident bedrooms, 2 resident bathrooms, office, living room with fireplace, dining area, kitchen, pantry, laundry area, backyard, and attached garage. LPA completed a walk through of facility, and review of records.

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 68 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were in good repair. Water temperature was not tested due to water not running. LPA observed that the water utility was cut off due to the facility being vacant. Technical violation issued. The facility is equipped with operational smoke detectors, carbon monoxide alarms, fire extinguisher and first aid kit. Posters such as; the personal rights, theft policy, CCL complaint poster were posted in a common area. Cleaning supplies, toxins, sharps, medications and other dangerous items were kept in secure cabinets inaccessible to residents. There was a designated storage space for resident/staff files. There are no guns, ammunition, swimming pool or bodies of water in the facility. LPA observed that the facility phone did not make or receive calls because the internet was disconnected. Technical violation issued.

Food Service: Non-perishable and perishable food supply will be purchased upon admission of residents. Dishes, cups, and utensils were also stored properly.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/31/2024
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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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: CHRISTIAN'S LOVE ELDERLY CARE FACILITY, LLC
FACILITY NUMBER: 365530127
VISIT DATE: 12/31/2024
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Yards/Outside: One shaded patio, a side gate with self-latching handle on the left and right side of the house that leads into the backyard. All outdoor pathways were free of obstructions.

Record Review: LPA reviewed licensee's file for First Aid/CPR certification, criminal record clearance, trainings, and health screening. The facility did not have any resident files due to being vacant with no previous residents.

No deficiencies and two technical violations were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, and LIC9102TV were discussed and copies were provided to the Licensee, Julia Uche.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024
LIC809 (FAS) - (06/04)
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