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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202943
Report Date: 10/15/2025
Date Signed: 10/15/2025 01:43:58 PM

Document Has Been Signed on 10/15/2025 01:43 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:LOVING HEART CARE HOMEFACILITY NUMBER:
435202943
ADMINISTRATOR/
DIRECTOR:		SILVA, ARMANDO N.FACILITY TYPE:
740
ADDRESS:251 DELIA STREETTELEPHONE:
(559) 572-9755
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 6CENSUS: 3DATE:
10/15/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Armando Silva, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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LIcensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced visit to continue the facility required 1-year inspection, met with the licensee/administrator (LIC/ADM) Armando Silva and stated the purpose of the visit.

In continuing the record review, LPA reviewed 3 Out of 3 resident record, such as but not limited to the Centrally Stored Medication and Destruction Record (CSMDR), physician's report, pre-placement appraisal and assessment report, appraisal needs and services plan, physician's report and admission agreement and found records to be complete an up-to-date.

Based on the observation, and record reviews from inspection conducted on 10/13/2025, citations are issued during today's visit based on the California Code of Regulations (CCR) Title 22. Articles cited 87705 Care of Persons with Dementia, 87411 Personnel Requirement, 87412 Personnel Record, 87303 Maintenance and operation and 87555 General Food Service Requirements.

An exit interview was conducted with Licensee/Administrator Armando Silva, a copy of the report and appeals rights were provided.

end of report.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2025
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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Document Has Been Signed on 10/15/2025 01:43 PM - It Cannot Be Edited


Created By: Maria Partoza On 10/15/2025 at 11:20 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: LOVING HEART CARE HOME
FACILITY NUMBER: 435202943

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(a)
Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above by not maintaining the ramp located at the back of the facility. The ramp are missing wood planks creating gap between planks. LPA observed that 3 planks of wood are rotting and soft when stepped on, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2025
Plan of Correction
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LIC/ADM stated he/she will submit a written plan of correction by the POC due date 10/16/2025, addressing the disrepair of the ramp at the back of the facility by notifying the landlord that repair is required to prevent tripping hazard. LIC ADM stated repair will start within 10 days after notification and approval of the landlord. LIC/ADM stated landlord is currently out of the country and will be back in 2 days (10/17/25). Plan to have the ramp repaired will be on 10/31/2025.
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based observation, the licensee did not comply with the section cited above by not maintaining water temperature between 105 to 120 degree F. When measured with a digital thermometer the water temperature in the kitchen sink and bathroom measured at 139.9 to 141.1 degree F, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2025
Plan of Correction
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LIC/ADM stated that he/she will submit a written plan of correction by the POC due date of 10/16/2025. LIC/ADM stated that the water temperature will be measured for two weeks, and logged to ensure the consistency that hot water is delivered at 105 degree F to 120 degree F. Logs will be emailed to LPA on a weekly basis. Log will be done from 10/16/25 up to 10/31/25.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Maria Partoza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/15/2025 01:43 PM - It Cannot Be Edited


Created By: Maria Partoza On 10/15/2025 at 12:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: LOVING HEART CARE HOME
FACILITY NUMBER: 435202943

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87412(c)(1)(A)
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (1) The following staff training and orientation shall be documented: (A)For staff who assist with personal activities of daily living, there shall be documentation of at least ten hours of initial training within the first four weeks of employment, and at least four hours of training annually thereafter in one or more of the content areas as specified in Section 87411(c)(2).


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not maintain a current record of training for S1 and S2 who assist with the personal acitvities of daily living. The certificate of training on file for S1 & S2 was from a previous employer that was administered in 2023 and is no longer in business, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2025
Plan of Correction
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LIC/ADM stated that he/she will submit a written plan of correction by the POC due date of 10/16/25, addressing the training requirement of all staff (S1 to S3) to ensure that current certificates are on record and trainings are done annually. LIC/ADM stated that staff will record continuing education provided and as required by the regulation. Trainig will start on 10/27/2025. LIC/ADM will email proof of training to LPA by 10/31/25.
Type A
Section Cited
CCR
87411(c)(1)
87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69
(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff record review the licensee did not comply with the section cited above in 3 Out of 3 staff 1st/Aid CPR are expired 2 out of 3 expired in 04/20/2025 and 1 out of 3 expired in 06/2025, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2025
Plan of Correction
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LIC/ADM stated that he/she will submit a written plan of correction by the POC due date of 10/16/25. LIC/ADM stated that the staff will have their updated CPR/1st aid training by 10/20/25. LIC/ADM will submit proof of training to LPA by 10/24/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Maria Partoza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/15/2025 01:43 PM - It Cannot Be Edited


Created By: Maria Partoza On 10/15/2025 at 12:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: LOVING HEART CARE HOME
FACILITY NUMBER: 435202943

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87705(b)(1)
87705 Care of Persons with Dementia (b) Licensees shall be responsible for the following: (1) Ensuring staff receive the ...training as part of the training requirements specified in Section 87208 Plan of Operation

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by not ensuring 3 out of 3 staff S1 to S3, have the current dementia training on record. Record indicates the dementia training was provided by previous employer who is no longer in business in 2023, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2025
Plan of Correction
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LIC/ADM stated that he/she will submit a written plan of correction by the POC due date of 10/16/25. LIC/ADM stated that he/she will administer the dementia training to all staff by 10/27/25 and will send proof of completion to LPA by 10/31/25.
Type A
Section Cited
CCR
87555(b)(23)
(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by not ensuring perishable food capable of supporitng rapid & progressinve growth of micro-organisham are stored in container at appropriate room temperature. LPA observed boxes of rotting fruits and vegetable at the side of the ramps exposed to the elements and attracts insects and rodents which pose an immediate health, safety and personal rights risks to persons in care.
POC Due Date: 10/16/2025
Plan of Correction
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LIC/ADM stated that he/she will submit a written plan of correction by the POC due date of 10/16/25. LIC ADM stated the boxes of fruits and vegetables that were exposed to the elements belongs to the landlord. LIC/ADM stated that he/she will have a dialogue with the landlord pertaining to the rotting food in boxes that were attracting insects and rodents. LIC/ADM stated that he/she will submit proof of correction by 10/31/25.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Maria Partoza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2025


LIC809 (FAS) - (06/04)
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