331881507-2-19-2026-18-AS-AFAI-DRG342-20260219165425

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881507
Report Date: 02/19/2026
Date Signed: 02/19/2026 04:55:31 PM

Document Has Been Signed on 02/19/2026 04:55 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	PATTY'S PLACE		FACILITY NUMBER:	331881507
ADMINISTRATOR/ DIRECTOR:	BARR, BOBBI JEAN		FACILITY TYPE:	740
ADDRESS:	25079 QUEBRADA COURT		TELEPHONE:	(951) 750-8656
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92557
CAPACITY: 6		CENSUS: 5	DATE:	02/19/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:45 PM
MET WITH:	James Aliviado - Caregiver		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

NARRATIVE

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On 04/19/26, Licensing Program Analysts (LPAs) Aziz Faizi and Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPAs were greeted and granted entry by caregiver James Aliviado who was informed of the purpose of the visit. Licensee Bobbie Barr was informed of the purpose of the phone via phone call

The facility is a one-story home with four (4) bedrooms, two (2) bathrooms and one (1) staff room including an attached garage. There are no pools or known firearms on the premises.

LPAs toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is available for the clients in care.

The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The living room was observed to have board games and other activities.

LPAs toured the kitchen and observed the facility has a two-day supply of perishable foods and more than a seven-day supply of non-perishable foods, which are stored in a safe and healthy manner. LPAs observed knives and sharp instruments secured in locked kitchen cabinets. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents.

Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 107.1°F. Fire extinguisher located in the kitchen meeting department's requirements expiring 11/7/2026.

NAME OF LICENSING PROGRAM MANAGER: Carolyn Tuba
NAME OF LICENSING PROGRAM ANALYST: Aziz Faizi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026

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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PATTY'S PLACE	FACILITY NUMBER: 331881507
	VISIT DATE: 02/19/2026

NARRATIVE

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During the visit, LPAs observed one staff present to supervise clients. The administrator holds a current administrator’s certificate expiring 1/15/2028.

LPAs reviewed files for one (1) staff member, confirming criminal clearances, updated training, and CPR/First Aid certification.

All resident medications were securely locked. LPA reviewed medications for two (2) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for.

LPAs reviewed the facility’s emergency and disaster plan, including documentation of the last fire/earthquake drill conducted on 01/2026, which met department requirements. All facility exits were clear of obstructions.

LPAs reviewed Resident 1's (R1's) signed physician's report dated 10/08/2025 documenting R1 is bedridden. LPAs also reviewed R1's signed admission agreement dated 10/09/2025. Licensee Bobbi Barr and Caregiver James Aliviado were interviewed and confirmed R1 is bedridden. Licensee was under the impression they had a fire clearance for two (2) bedridden residents. However, the facility has a fire clearance for six (6) non-ambulatory residents only and an approved for a hospice waiver for two (2). Licensee expressed interest in submitting a change of ambulatory status application to Community Care Licensing to request a fire clearance for a bedridden resident to allow R1 to remain in the facility.

Based on the aforementioned, the facility was cited for California Code of Regulations (CCR) Section 87202(a)(2) for R1 who is bedridden, while the facility is not approved to accept bedridden residents by the local fire jurisdiction and a civil penalty was assessed. An exit interview was conducted, during which this report, Confidential Names list (LIC 811), LIC-809D, LIC 421IM, and Appeal Rights were reviewed over the phone with licensee and provided to Caregiver Aliviado.

NAME OF LICENSING PROGRAM MANAGER: Carolyn Tuba
NAME OF LICENSING PROGRAM ANALYST: Aziz Faizi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/19/2026 04:55 PM - It Cannot Be Edited

Created By: Aziz Faizi On 02/19/2026 at 04:06 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: PATTY'S PLACE	FACILITY NUMBER: 331881507
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/19/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87202(a)(2)

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: (2) Bedridden persons This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above due to Resident 1 (R1) being identified and listed as bedridden when the facility does not have a fire a cleareance to accept bedridden residents. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/20/2026
	Plan of Correction
1 2 3 4	Licensee to call the local fire department to inform them R1 is bedridden and residing in the facility. Licensee is also to submit an updated LIC200 and facility sketch to Community Care Licensing to begin the process of requesting a change of ambulatory status to include a fire clearance for a bedridden resident. Plan of correction due by close of business on 02/20/2026.

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.

	Carolyn Tuba
NAME OF LICENSING PROGRAM MANAGER:

	Aziz Faizi
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026

LIC809 (FAS) - (06/04)

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