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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530062
Report Date: 01/30/2025
Date Signed: 01/30/2025 02:05:15 PM

Document Has Been Signed on 01/30/2025 02:05 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:TWIN HEARTS SENIOR CARE IIFACILITY NUMBER:
335530062
ADMINISTRATOR/
DIRECTOR:		MANGENTE, KRISTINEFACILITY TYPE:
740
ADDRESS:342 E OLIVE STREETTELEPHONE:
(951) 373-9122
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY: 6CENSUS: 6DATE:
01/30/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Caregiver- Juwita P ElisabethTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to verify clearance of Plan of Correction from visit on 1/24/2025. LPA Rico met with caregiver Juwita P. Elisabeth and was granted entry to the facility. During today's visit, Administrator Kristine Mangente was contacted and informed of the visit.

The following deficiencies were not cleared during the time of the visit:

The Licensee was cited on 1/24/2025 the facility was cited on 87307(a) Personal Accommodation and Services. During today's facility tour, LPA observed S1 bed mattress is still located inside R1 mattress closet. S1 confirmed they're still sleeping inside resident closet. The Plan of Correction was to remove S1 bed mattress and provide proof to LPA Rico. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for (3) days.

The Licensee was cited on 1/24/2025 the facility was cited on 87608(a)(5)(B) Postural Supports. During today's facility tour, LPA observed 3 out of the 6 residents had full bed rails. The Plan of Correction was to remove the full bed rails and train staff on the regulation cited. In addition, provide proof to LPA Rico.Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for (3) days.

The Licensee was cited on 1/24/2025 the facility was cited on 87355(e)(3)Criminal Record Clearance. During today's facility tour, and record review. LPA Rico observed S1 and S2 working without having their criminal record clearance associated to the facility. The Plan of Correction was to associate S1 and S2 clearance to the facility and send proof to LPA Rico.Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for (3) days.

An exit interview was conducted and this report, LIC809 along with Civil Penalty Assessment pages, and Appeal Rights were reviewed and provided to caregiver Juwita P. Elisabeth.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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