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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336423972
Report Date: 05/27/2025
Date Signed: 05/27/2025 03:56:05 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/10/2023 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20231010135218
FACILITY NAME:WHITE'S LOVE & CARE RESIDENTIAL ELDERLY HOME INCIIFACILITY NUMBER:
336423972
ADMINISTRATOR:JACQUELYN J. WHITEFACILITY TYPE:
740
ADDRESS:24068 RISTRAS LANETELEPHONE:
(951) 319-6622
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:6CENSUS: 3DATE:
05/27/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Staff, Krista HaganTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Licensee is resident's responsible party.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Staff, Krista Hagan and met with Administrator, Armond Hagan over the phone who were informed of the purpose of the visit. During the visit, LPA conducted interviews, conducted a walk through, and conducted records review.

It was alleged “Licensee is resident's responsible party.” It was alleged the licensee was Resident #1 (R1)’s Power of Attorney (POA).
The department attempted to conduct interview with R1 who was not alert or oriented at the time of the interview. LPA attempted to interview the licensee who was not available at the time of the visit. The department conducted (2) staff interviews which revealed that the licensee is the POA for R1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 18-AS-20231010135218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: WHITE'S LOVE & CARE RESIDENTIAL ELDERLY HOME INCII
FACILITY NUMBER: 336423972
VISIT DATE: 05/27/2025
NARRATIVE
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POA documents for R1 revealed the licensee is the POA over Financial Management and a facility staff is the POA for Health Care. Emergency Contact Sheet for R1 and LIC602 Physician’s Report revealed the licensee signed as R1’s POA. Facility file review revealed complaint #18-AS-20191201121045 which was substantiated for the licensee being R1’s POA.

Therefore, based on interviews and record review the allegation that the licensee was the POA for R1 is substantiated at this time. The preponderance of evidence standard has been met, therefore the above allegation is substantiated. California Code of Regulations Title 22 is being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report, LIC9099 D page, and appeal rights were reviewed and provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20231010135218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: WHITE'S LOVE & CARE RESIDENTIAL ELDERLY HOME INCII
FACILITY NUMBER: 336423972
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/28/2025
Section Cited
CCR
87217(d)(2)
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87217 Safeguards for Resident Cash, Personal Property, and Valuables
(d)…no licensee…shall: (2) accept any general or special power of attorney for any such person; This requirement was not met as evidenced by:
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The licensee is to call Adult Protective Services (APS) and initate the process to assist R1 in finding a new POA who is not affiliated with the facility. The licensee is to submit proof of this by the POC due date.
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Based on interview and record review the licensee was the POA for R1 which poses an immediate health saftey or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3