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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530389
Report Date: 03/12/2026
Date Signed: 03/12/2026 10:45:11 AM

Document Has Been Signed on 03/12/2026 10:45 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:CARING HANDS RESIDENTIAL CAREFACILITY NUMBER:
365530389
ADMINISTRATOR/
DIRECTOR:		IFTIKHAR, TAJWARFACILITY TYPE:
740
ADDRESS:7183 HELENA PLTELEPHONE:
(909) 320-7465
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 6CENSUS: 2DATE:
03/12/2026
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Facility Licensee Syed IftikharTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 3/12/2026, Licensing Program Analyst(LPA) Beena Singh conducted an unannounced post licensing visit. LPA was granted entrance by a Staff and Licensee Syed Iftikhar was contacted/informed and arrived during the visit. A tour of the facility was conducted inside and out of physical plant. Current census is two(2), one(1) resident present at the facility and one(1) is out in the community attending day program. There were two (2) staff present at the facility.

The facility is approved for six (6) Non- Ambulatory Residents and Hospice Waiver for three (3). Dementia Plan is in place. An initial application to operate a Residential Facility for Elderly (RCFE)was submitted to the Central Applications Bureau (CAB) on 04/08/2025 for a total capacity of six (6) non-ambulatory. Fire clearance was granted on 08/05/25. LPA Singh observed the following:

Facility is a one (1) story house with four (4) bedrooms, three (3) bathrooms, living room, dining area and kitchen. There was a two (2) car garage in the right side of the house. The inspection consisted of but was not limited to the following: Physical plant; bedrooms, bathrooms, living room, family room, kitchen, dining area, storage closets, laundry room, and outside premises.

Each resident bedrooms accommodate any non-ambulatory resident. All resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, a lamp and an operable smoke/carbon monoxide alarm.There was a living/family room with adequate seating for all clients and a working TV.An adequate supply of linens was stored in a cabinet in the hallway of the residence.
NAME OF LICENSING PROGRAM MANAGER: Efren Malagon
NAME OF LICENSING PROGRAM ANALYST: Beena Singh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2026
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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CARING HANDS RESIDENTIAL CARE
FACILITY NUMBER: 365530389
VISIT DATE: 03/12/2026
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Patio furniture for outdoor seating observed. Self-latching handle gate on right side of the house leads into the backyard. All outdoor pathways were free of obstructions. Staff maintain resident medication records and medications are centrally stored in a locked cabinet. Two (2) resident files were reviewed for admission agreements, physician's reports, appraisals, needs and services plans. Two (2) staff files were reviewed First Aid/CPR certifications, criminal record clearances, personal record/history, training and health screenings. There is enough Emergency water supply and the required 72-hour emergency food supply for residents and staff available at the facility.
Facility sketches were observed posted near the main entrance office. There was Let-Us-No poster, emergency disaster, personal rights, and Labor Laws observed.

One (1) fire extinguisher was charged and located in the dining room/kitchen. Two (2) combined smoke detectors and carbon monoxide detectors were tested and were observed to be in working order. Residents records and staff records are stored in a locked cabinet in the hallway. First Aid kit with required components, and locked area for medication storage was observed.

Liability Insurance effective date 3/9/2026-3/9/2027.



The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of clients in care. Facility appears to be ready for license.

An exit interview was conducted, and a copy of this report, LIC809 was discussed and provided to Facility Licensee Syed Iftikhar.
NAME OF LICENSING PROGRAM MANAGER: Efren Malagon
NAME OF LICENSING PROGRAM ANALYST: Beena Singh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC809 (FAS) - (06/04)
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