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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881591
Report Date: 06/12/2026
Date Signed: 06/12/2026 05:05:48 PM

Document Has Been Signed on 06/12/2026 05:05 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:A PLACE OF LOVE ADULT AND SENIOR HOMES INCFACILITY NUMBER:
331881591
ADMINISTRATOR/
DIRECTOR:		MOJICA, FLORENCEFACILITY TYPE:
740
ADDRESS:4885 E CHARLTON AVETELEPHONE:
(951) 392-3788
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY: 6CENSUS: 6DATE:
06/12/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Florence Mojica, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Yolanda Delgado conducted case management to check on the Health & Safety of the residents in care. LPA conducted walk through the facility accompanied by Resident #1 (R1), LPA observed six (6) residents at the facility, working utilities, perishables and non-perishables observed, medications, sharps and toxins were not locked, not stored and readily accessible to residents in care.

LPA contacted Licensee/Administrator Florence Mojica and it was stated the live-in caregiver had an emergency and left the facility and she was notified at 10:15 that the caregiver was seeking medical attention. LPA to stand by for Licensee/Administrator. Licensee/Administrator arrived during the visit, during interviews it was determined that there are concerning issues and an Informal Office meeting will be scheduled with Florence Mojica to address concerns and change of Ownership information that was provided on this day.

The facility will be cited Title 22, Division 6, Chapter 8, Article 08, Section 87464(c), Article 05, Section 87309(a), Section 87303(g), Article 02, Section 87109 (b) with Civil Penalties that will be issued for a total of $1,000.

An exit interview was conducted with Florence Mojica and a copy of this report, LIC809D, LIC421IM and Appeal Rights was provided.

NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Yolanda Delgado
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2026
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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Document Has Been Signed on 06/12/2026 05:05 PM - It Cannot Be Edited


Created By: Yolanda Delgado On 06/12/2026 at 04:14 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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: A PLACE OF LOVE ADULT AND SENIOR HOMES INC
FACILITY NUMBER: 331881591

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2026
Section Cited
HSC
87464(c)

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Basic Services: "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care.
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Licensee has contacted additional caregivers at other facility to provide coverage, coverage has been confirmed and will contact a staffing agency if needed. Licensee will submit an updated work schedule for the remainder of the month and email to LPA by POC due date.
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This requirement was not being met as evidenced by: During a facility visit on 6/12/2026, LPA observed 6 residents at the facility without any staff to provide care and supervision. Licensee was contacted and informed the live-in caregiver went to seek medical attention without notifying her. LPA stood by for Licensee to arrive. This poses an immediate health and safety risk to residents in care.
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Type A
06/13/2026
Section Cited
HSC87309(a)

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Storage Space and Access: (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
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Licensee will ensure that all items identified are locked, secured and inaccessible to all residents in care, provide In-service training to staff and submit the training sheet to LPA by POC due date.
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This requirement was not being met as evidenced by: During a facility visit on 6/12/2026, LPA observed medications, a dirty metal knife in the sink, sharps in unlocked drawer, toxic chemicals in the garage floor, items were not locked secured and readily accessible to residents. LPA stood by for Licensee to arrive. This poses an immediate health and safety 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.
Anthony Perez
NAME OF LICENSING PROGRAM MANAGER:
Yolanda Delgado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/12/2026 05:05 PM - It Cannot Be Edited


Created By: Yolanda Delgado On 06/12/2026 at 04:31 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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: A PLACE OF LOVE ADULT AND SENIOR HOMES INC
FACILITY NUMBER: 331881591

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2026
Section Cited
CCR
87303(g)

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Maintenance and Operation: Facilities which have machines and do their own laundry shall: (1) Have adequate supplies available and equipment maintained in good repair. Space used to sort soiled linen shall be separate from the clean linen storage and handling area...
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Licensee will obtain a working dryer for the facility and email a photograph of the dryer plugged in and working to LPA by POC due date.
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This requirement was not being met as evidenced by: During a facility visit on 6/12/2026, LPA observed clothing hanging over furniture and on hangers inside the garage. Interview revealed there is no dryer available for residents to dry their clothing after washing. This poses an immediate health and safety risk to residents in care.
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Type B
06/19/2026
Section Cited
CCR87109(b)

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Transferability of License: The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least thirty (30) days prior to the transfer of the property or business, or at the time that a bona fide offer is made, whichever period is longer, as specified in Health and Safety Code Section 1569.191.

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Licensee will submit the letter of Change of Ownership and the letters of notification to the residents to LPA by POC due date.
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This requirement was not being met as evidenced by: During a facility visit on 6/12/2026, LPA was told by the Licensee that she has sold the business to another person and she notified CCLD. LPA contacted Support Staff and no information for Change of Ownership has been received. This poses an immediate health and safety 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.
Anthony Perez
NAME OF LICENSING PROGRAM MANAGER:
Yolanda Delgado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2026


LIC809 (FAS) - (06/04)
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