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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423972
Report Date: 07/03/2025
Date Signed: 07/03/2025 03:27:37 PM

Document Has Been Signed on 07/03/2025 03:27 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:WHITE'S LOVE & CARE RESIDENTIAL ELDERLY HOME INCIIFACILITY NUMBER:
336423972
ADMINISTRATOR/
DIRECTOR:		JACQUELYN J. WHITEFACILITY TYPE:
740
ADDRESS:24068 RISTRAS LANETELEPHONE:
(951) 319-6622
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY: 6CENSUS: 2DATE:
07/03/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Administrator, Aidan HaganTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced Plan of Correction (POC) Visit. LPA met with Administrator, Armond Hagan, and later met with Staff, Aidan Hagan who were informed of the purpose of the visit. LPA made (3) attempts to contact the licensee during the visit but no response was received. LPA conducted a walk through, interviews, and records review to verify the POC from visits conducted on 06/11/2025 and 07/01/2025.

The following deficiencies were corrected by the POC due date. The POC's were cleared at the time of the visit:

Deficiency cited under California Code of Regulations (CCR) Title 22 section 87202 Fire Clearance for the facility exceeding the capacity for residents who are bedridden. The licensee agreed to have the resident relocated and apply for an increase in their bedridden status to the local fire department by POC due date of 07/02/2025. The Department received copy of 30- day eviction notice for the bedridden resident, and proof of appointment with the local fire jurisdiction. Therefore, the POC was met and cleared at the time of the visit.

Deficiency cited under CCR Title 22 section Maintenance and Operation 87303 for the facility smoke detectors not having batteries. The staff replaced the batteries for the smoke detectors on 07/01/2025, and on today's visit 07/03/2025 the smoke detectors were tested and observed to be operational. Therefore, the POC was met and cleared at the time of the visit.

NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Janira Arreola
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2025
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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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: WHITE'S LOVE & CARE RESIDENTIAL ELDERLY HOME INCII
FACILITY NUMBER: 336423972
VISIT DATE: 07/03/2025
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Deficiency cited under CCR Title 22 section 87355 Criminal Record Clearance for uncleared adult observed be sleeping over night at the facility with their clothing and personal belongings in a vacant resident room. On 07/01/2025, the uncleared adult was escorted off the premises, and on today's visit 07/03/2025 the uncleared adult was not observed at the facility. LPA observed (2) cleared staff at the facility at the time of the visit. Therefore, the POC was met and cleared at the time of the visit.

The following deficiencies were not corrected by the POC due date nor at the time of the visit. Civil Penalties are being assessed and will continue to accrue until the POC has been submitted:

Deficiency cited under CCR Title 22 section 87205 Accountability of Licensee Governing Body for the licensee WHITE'S LOVE AND CARE RESIDENTIAL ELDERLY HOME INC being in a status of suspension with the Franchise Tax Board (FTB). POC was to contact the FTB and obtain proof of agreement to bring the incorporation back into good standing. On 6/19/2025 the licensee met with Department staff in office and agreed to submit the POC by the POC due date 06/20/2025. LPA received phone communication from the licensee’s husband on 06/20/2025 informing they had called the FTB and left a voicemail message. No further proof was submitted for the POC. During today’s visit LPA attempted to speak with Licensee, Jacqueline White who was unavailable at the time of the visit. The Secretary of State website was checked on today's date which still reflect a status of suspension with the FTB. Therefore, the POC was not met and civil penalties are being assessed in the amount of $100 per day for (12) days from 06/21/2025 to 07/02/2025. The licensee was advised that civil penalties will continue to accrue at the rate of $100 a day until the POC is met.

An exit interview was conducted with the staff, Aidan Hagan where this report, LIC421FC Faliure to correct Forms, appeal rights, and Clearance Letters were reviewed and provided. *LPA was off site from 12:05pm to 1:49pm in order to prepare today's report.

NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Janira Arreola
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC809 (FAS) - (06/04)
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