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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880858
Report Date: 12/17/2025
Date Signed: 12/17/2025 11:31:55 AM

Document Has Been Signed on 12/17/2025 11:31 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ALONDRA RESIDENTIAL CARE FACILITYFACILITY NUMBER:
331880858
ADMINISTRATOR/
DIRECTOR:		TUMALIUAN, MARIA DIANAFACILITY TYPE:
740
ADDRESS:40534 ALONDRA DRIVETELEPHONE:
(951) 416-4717
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY: 6CENSUS: 6DATE:
12/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:staff Nathaniel HernandezTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
NARRATIVE
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On 12/17/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of conducting the 1-year required visit. LPA met with staff Nathaniel Hernandez and explained to Nathaniel the purpose of the visit. LPA conducted a tour alongside Nathaniel and observed the following:

The facility is a single-store structure which consist of (4) four resident bedrooms, (1) staff bedroom, (2) bathrooms, laundry room, living room, dining room, garage, and backyard. Backyard area was observed to have a covered patio that was fully furnished. Indoor and outdoor passageways were free from obstruction. Resident bedrooms were equipped with the required bedding, furniture, and functional lighting. During visit, LPA observed staff encouraging residents to go outside to promote socialization. The facility maintained a (2) two-day supply of perishable foods and a (7) seven-day supply of non-perishable foods. LPA observed an additional refrigerator in the garage for the overflow food designated for the residents and staff. The facility maintained emergency food and water in the garage. The kitchen was kept clean and free of debris. LPA observed a locked cabinet in the kitchen designated for knives and other sharp items. Cleaning solutions and other disinfectants were kept in a locked cabinet under the kitchen sink. Dual smoke and carbon monoxide detectors were tested and observed to be fully operable. LPA observed a hallway cabinet that stored additional linen for resident use. Per staff Nathaniel, there are no firearms and/or ammunition on the premises.
LPA reviewed (5) five out of (6) six resident records. Records included but not limited to signed admission agreement, physician reports, preplacement appraisals, and needs and service plans.

(Continue to LIC809C...)
NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Valerie Flores
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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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Document Has Been Signed on 12/17/2025 11:31 AM - It Cannot Be Edited


Created By: Valerie Flores On 12/17/2025 at 10:42 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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ALONDRA RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 331880858

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87202(a)
Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, observation, and records review, the licensee did not comply with the section cited above as during the annual require visit, LPA discovered that Resident #1 (R1) has an ambulatory status of bedridden. LPA requested to review the approved fire clearance and was advised that the facility did not maintain a copy onsite for LPA's review which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/19/2025
Plan of Correction
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Managing members are to review Title 22 Article 4, Operating Requirements, and provide LPA with a signed affidavit confirming that all sections were reviewed. The signed affidavit is to be forwarded to LPA by close of business, 12/19/2025.
Type A
Section Cited
CCR
87606(c)
Care of Bedridden Residents
(c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, licensee did not comply with the section cited above in (1) one out of (6) six clients has an ambulatory status of bedridden. Upon reviewing the facility license, the Licensee cannot retain any residents who have an ambulatory status of bedridden which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/18/2025
Plan of Correction
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Administrator/Licensee are to submit to the licensing department an updated LIC200 and facility sketch to begin the process updating the current fire clearance by close of business on 12/18/2025. Administrator/Licensee will complete an out-service training on RCFE acceptance and retention limitations. The training certificate must be completed by all managing members and forward to LPA via email by close of business on 1/2/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Anthony Perez
NAME OF LICENSING PROGRAM MANAGER:
Valerie Flores
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2025


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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ALONDRA RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 331880858
VISIT DATE: 12/17/2025
NARRATIVE
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(Continuation from LIC809C)

(1) one out of (6) six residents did not have a completed file as they have not resided in the facility for a total of (30) thirty days. LPA reviewed (3) three staff records. Records included but not limited to health screening, background clearance, personnel reports, and relevant training's. During the tour LPA did not observe a posted fire clearance. Upon request, LPA was advised that the document cannot be provide for review as it was not maintained at the facility. Therefore, a citation will be issued in accordance to Title 22 Regulations. Upon records review and interview, LPA discovered that the Licensee retains a resident with a bedridden ambulatory status. The facility is not licensed to accept any bedridden residents. Therefore, a citation will be issued in accordance to Title 22 Regulations.

An exit interview was conducted with staff Nathaniel Hernandez, and a copy of the LIC809, LIC809C LIC809G, LIC809D, and appeal rights were provided to the Administrator.
NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Valerie Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC809 (FAS) - (06/04)
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