366412237-10-6-2025-56-AS-MMAE-DM7U7E-20251006151950

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366412237
Report Date: 10/06/2025
Date Signed: 10/06/2025 03:20:42 PM

Document Has Been Signed on 10/06/2025 03:20 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:	LOVING CARE RANCH		FACILITY NUMBER:	366412237
ADMINISTRATOR/ DIRECTOR:	TERESA G. DATUIN		FACILITY TYPE:	740
ADDRESS:	25445 NATIONAL TRAIL HWY		TELEPHONE:	(760) 245-4523
CITY:	HELENDALE	STATE: CA	ZIP CODE:	92342
CAPACITY: 18		CENSUS: 9	DATE:	10/06/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:10 AM
MET WITH:	Lily Mayo		TIME VISIT/ INSPECTION COMPLETED:	03:25 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	Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with staff, Lily Mayo and discussed the purpose of the visit. The facility is Residential Care Facility for the Elderly (RCFE) and consists of three (3) one story buildings. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility has no swimming pools or similar bodies of water. Outdoor activity area is gated and sufficient for client activities. Indoor areas are sufficient for client activities and facility is maintained at 74 degrees F. The facility has operating carbon monoxide/smoke alarms, fully charged fire extinguishers, first aid kits, laundry equipment, hallway night lights and telephone service. The facility has posted in a common area, Ombudsman poster, Personal Rights, facility license, evacuation sketch plan and emergency telephone numbers. LPA observed cleaning supplies kept unlocked and unattended in two (2) resident bathrooms and in two (2) laundry rooms. Resident bedrooms were equipped with mattresses, bed linen, dressers, chairs, and lighting. LPA observed in Ranch building #1, resident #1 (R1's) bedroom was being used as a passageway into the staff sitting area and back bedrooms. Resident bathrooms were kept clean and equipped with grab rails and slip mats. The hot water temperatures in residents' bathrooms measured 105 and 112 degrees F. Food Service: Facility's kitchen and dining areas were maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. The facility has sufficient cups, plates and utensils for resident use. The facility has a posted weekly menu.

NAME OF LICENSING PROGRAM MANAGER: Karen Clemons
NAME OF LICENSING PROGRAM ANALYST: Magda Malcore
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

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: LOVING CARE RANCH	FACILITY NUMBER: 366412237
	VISIT DATE: 10/06/2025

NARRATIVE

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Medical Related Services: Staff maintain record of client medications and resident medications are centrally stored in locked closets.

Record Review: LPA reviewed resident records for Admissions agreements, personal property records, emergency contacts, medical and appraisal records. LPA review of staff files reveals Staff#1 (S1) did not have a health screening with tuberculosis(TB) or chest x-ray screening on file. S1, staff #2(S2), staff #3(S3) did not have record of annual dementia and hospice training on file for review. S2 informed LPA that they and S3 administer medications to the residents. S2 and S3 did not have record of annual medication administration training on file for review.

During today's visit, Deficiencies were cited and technical advisories were issued in accordance with Title 22 of the California Code of Regulations.

An exit interview was conducted where this report was discussed. Copies with appeal rights were provided at the conclusion of the visit.

NAME OF LICENSING PROGRAM MANAGER: Karen Clemons
NAME OF LICENSING PROGRAM ANALYST: Magda Malcore
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/06/2025 03:20 PM - It Cannot Be Edited

Created By: Magda Malcore On 10/06/2025 at 01:48 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: LOVING CARE RANCH	FACILITY NUMBER: 366412237
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87309(a)

Storage Space and Access

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observations, the licensee did not comply with the section cited above by cleaning supplies were kept unlocked and unattended by staff in resident bathrooms and laundry room; which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/07/2025
	Plan of Correction
1 2 3 4	Staff removed the cleaning supplies and placed them in locked cabinets.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/06/2025 03:20 PM - It Cannot Be Edited

Created By: Magda Malcore On 10/06/2025 at 01:48 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: LOVING CARE RANCH	FACILITY NUMBER: 366412237
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87411(f)

Personnel Requirements - General

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observations, the licensee did not comply with the section cited above by staff #1 (S1) did not have a health screening with tuberculosis(TB) or chest x-ray screening on file for LPA review; which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2025
	Plan of Correction
1 2 3 4	The Licensee/Administrator shall provide to the licensing agency by POC due date, documentation of S1's health screening and TB results.

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: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/06/2025 03:20 PM - It Cannot Be Edited

Created By: Magda Malcore On 10/06/2025 at 01:48 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: LOVING CARE RANCH	FACILITY NUMBER: 366412237
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Type B

Section Cited

HSC

1569.625(b)(2)

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observations, the licensee did not comply with the section cited above by not maintaining documenation of direct care staff #1 (S1), staff #2 (S2) and staff #3(S3) annual dementia and hospice training; which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2025
	Plan of Correction
1 2 3 4	The Licensee/Administrator shall provide to the Licensing Agency by POC due date, documentation of staff's annual dementia & hospice training.

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: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

LIC809 (FAS) - (06/04)

Page: 6 of 13

Document Has Been Signed on 10/06/2025 03:20 PM - It Cannot Be Edited

Created By: Magda Malcore On 10/06/2025 at 01:48 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: LOVING CARE RANCH	FACILITY NUMBER: 366412237
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87307(a)(2)(C)

87307 Personal Accommodations and Services (a)Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (C)No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observations, the licensee did not comply with the section cited above by resident #1 (R1's) room was being used as a passageway into staff's sitting area and back bedrooms;which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2025
	Plan of Correction
1 2 3 4	The Licensee/Administrator shall submit to the Licensing Agency by POC due date, proof that R1's bedroom is no longer being used as a passage way to other rooms.

Type B

Section Cited

HSC

1569.69(b)

(b) Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's record review, the licensee did not comply with the section cited above by staff #2 (S2) and staff#3 (S3) did not have record of annual medication administration training on file for review; which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2025
	Plan of Correction
1 2 3 4	The Licensee/Administrator shall provided to the Licensing Agency by POC due date, documentation of annual medication training for S2 and S3.

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: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

LIC809 (FAS) - (06/04)

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