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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336408381
Report Date: 03/17/2025
Date Signed: 03/17/2025 11:48:57 AM

Document Has Been Signed on 03/17/2025 11:48 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:ST. MARY'S LOVE AND CARE HOMEFACILITY NUMBER:
336408381
ADMINISTRATOR/
DIRECTOR:		JANARD LANSANGANFACILITY TYPE:
740
ADDRESS:74039 KOKOPELLI CIRCLETELEPHONE:
(760) 779-9887
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY: 6CENSUS: 6DATE:
03/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:24 AM
MET WITH:Administrator, Philip Christian AbayaTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 03/17/25 Licensing Program Analyst (LPA) Debbie Palacios conducted an unannounced one (1) year required visit. LPA was granted entry by caregiver, Aquilina Latayan, who was informed of the purpose of visit; Administrator Philip Abaya arrived shortly after. At the time of the visit there were two (2) caregivers, Administrator and six (6) residents present. All staff present were observed to have obtained proper fingerprint clearance and were associated to the facility. LPA observed the following during today's visit:

LPA conducted a tour of the facility with caregiver, Aquilina. The physical plant is a single story structure that contained four (4) resident bedrooms, one (1) staff bedroom, and three (3) bathrooms. The facility has a (1) formal dining rooms, kitchen, living room, an office area,garage, and a gated backyard. Indoor and outdoor passageways were free of obstruction. LPA observed an in-ground pool in the backyard, which was gated and locked. The facility has more than a two (2) day supply of perishable food and seven (7) day supply of non-perishable foods. Extra linen were observed in two (2) separate closets located in the hallway. There were two (2) freezers observed in the garage that were observed to be fully stocked. Dishes and utensils were in sufficient supply and in good repair. Knives and sharp items were observed in a locked kitchen cabinet. Resident bedrooms had the required bedding, furniture, and lighting. The smoke and carbon monoxide detectors were tested and were observed to be operable. Centrally stored medications were observed in a locked kitchen cabinet. The outdoor patio was observed to have shaded seating to encourage outdoors socialization. Two (2) fully charged fire extinguishers were observed in the facility. The facility was observed to be in a clean condition; free of dirt, insects, rodents, and pests. LPA observed that the laundry room was locked and had the cleaning supplies and detergents locked in a cabinet.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
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 2
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: ST. MARY'S LOVE AND CARE HOME
FACILITY NUMBER: 336408381
VISIT DATE: 03/17/2025
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Staff files reviewed include but not limited to have personnel records, health screenings, criminal record clearance, required training, and valid first aid/CPR certification. Administrator certificate is current until 04/22/26. Resident files included but are not limited to signed admission agreements, pre-placement, personal rights, needs and service plans, and updated physician reports. Facility sketch, CCL complaint poster, license and emergency disaster plan is posted on a wall located in the living room.

During today's visit, LPA did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC809 (FAS) - (06/04)
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