Forever Love Home Care

Type of visit: Annual/Random

On 9/09/2026 at approximately 10:20 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the Administrator, Mark Belmonte and stated the reason for their visit. LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 12:00 PM and the following was noted: The facility is a single-story building with six (6) bedrooms and three (3) bathrooms. The facility is currently occupying four (4) residents. There is a designated staff room. The facility has an approved fire clearance for six (6) non-ambulatory residents of which one (1) may be bedridden. Hospice waiver approved for four (4). Common areas: The living rooms and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 73°F. LPA observed a fire extinguisher to be located near the kitchen and dated 01/13/2026. LPA observed required postings such as Long-Term Care Ombudsman, See/Say Something, and Personal Rights to be located throughout the common areas. A working telephone was observed. LPA observed the fireplace to be covered and inaccessible to residents. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked kitchen drawers. The cleaning solutions/toxins were observed to be kept locked underneath the kitchen sink. Kitchen appliances were observed to be working and in proper condition. (continued on LIC 809-C) Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed to be stored in a closet located within the hallway’s passageway. Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. LPA observed there to be a shed. There is no body of water located at the facility. Laundry Room: The laundry room was observed to be kept locked. The laundry appliances were observed to be in proper condition. LPA observed cleaning solutions and toxins stored appropriately within the laundry room and inaccessible to residents. Garage: The garage can be accessed from inside of the facility and observed to be located next to the laundry room. The garage was observed to be kept locked and used for storage purposes. Extra refrigerators with additional food for residents was observed. Medications: The medications were observed to be kept in locked cabinets located in the kitchen. First-aid kit observed to be equipped with but not limited to bandages, digital thermometer, tweezer and First-Aid Manuel. Smoke detectors and carbon monoxide observed to be working properly and were tested. Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete. Staff records: LPA conducted a complete file review of two (2) staff records. Staff records appeared to be complete and updated. LPA observed a former residents medication to be stored in the staff room which was observed to be unlocked. Citation issued. Please refer to LIC 809-D. LPA along with the Administrator created the Plan of Correction (POC) regarding the citation. There were no other immediate health and safety hazards observed during the day of inspection. Exit interview was conducted, appeal rights given, and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Sep 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(i) · Plan of correction due date: Sep 10, 2026

87465 Incidental Medical and Dental. (i) Prescription medications which are not taken with the resident upon termination of services... shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. This requirement was not met evidenced by: Based on interviews, record review and observations 1 of 1 former resident's medication had not been destroyed and was kept in unlocked staff room which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: The Administrator/Licensee will review the regulation and email LPA Segovia a statement of understanding along with record of destruction of medication.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Annual Required visit for this facility. LPA met with the administrator, Mark Belmonte and explained the reason for the visit. The facility is licensed for a total capacity of six (06) with fire clearance for five (05) non-ambulatory residents, and one (01) bedridden. At approximately 12:00 p.m., LPA and administrator toured the physical plant of the facility inside and out and the following was observed: At entry LPA observed a sign in log for visitors and a digital thermometer affixed to the wall. LPA observed appropriate postings. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of two day perishable and seven day non-perishable food at the facility, properly stored. Knives and sharps were stored in a locked kitchen drawer. LPA observed cleaning supplies locked under the kitchen sink cabinet. Centrally stored medication was observed locked in a kitchen cabinet. One (01) fire extinguisher in the kitchen was observed fully charged with service date 07/12/2024. Surrounding Grounds: Entry/exits were free of obstructions. The outdoor patio offers shade and there was furniture appropriate for outdoor use. The outdoor area was free of hazards and fenced in. No bodies of water observed. There are dual carbon monoxide and smoke detectors that are hard wired and interconnected though out the facility. Administrator tested detectors at 12:25 p.m., and LPA observed detectors functioning properly. Fire door closed when test was conducted. (Continue to LIC809) (Continued from LIC809) Bedrooms: Five (5) bedrooms are designated for resident use one (1) of which may be shared. Bedrooms were observed to be properly furnished with appropriate furniture, bedding and sufficient storage and lighting. One (1) hallway cabinet was observed to have first aid kit and first aid kit supplies. Another closet stored extra linens and towels. Bathrooms: There are three (3) bathrooms available for residents' use. Bathrooms were supplied with toilet paper, paper towels, hand soap, nonskid matts and grab bars. LPA observed night-lights in the hallway leading to the bathrooms. Hot water temperature was measured from two (02) bathrooms at 12:30 p.m., and read 111 degrees Fahrenheit, within regulation. Common Areas: These included the living rooms and dining area. The common areas were clean and clear of clutter, properly furnished. The dining room table is large enough to sit the capacity of the facility. Seating such as couches and arm chairs where in good repair and sit the capacity of the facility. A fireplace was observed off and secured with a screen. During visit LPA observed residents sitting in the living room with family visitors. LPA observed two (2) portable telephones accessible to residents. Laundry and Garage: The laundry room is located in the hallway by the residents' rooms and leads to the attached garage. Laundry room was observed locked. Detergents and cleaning supplies were observed locked in the laundry room. LPA observed a freezer and a refrigerator in the garage with extra food. Resident, Staff, and Facility Files: At 12:57 p.m., LPA conducted a file review of five (5) out of five (5) resident records to ensure compliance of licensing forms. LPA also conducted a file review of two (2) staff records to ensure forms and training are up to date and in compliance with licensing forms. LPA reviewed facility's liability insurance and emergency disaster plan (LIC610E.) Facility had not documented an emergency disaster drill for their last quarter. Medications: At 2:27 p.m., LPA reviewed Medication and Medication Records. Medications were reviewed for proper storage and documentation. Facility also maintains a Medication Administration Record (MAR). Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Jul 8, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Evelin Rios conducted an Annual Required visit for this facility. LPA met with the administrator, Mark Belmont and administrator designee Mylene Veatch and explained the reason for the visit. The facility is licensed for a total capacity of 6 with fire clearance for five (5) non-ambulatory residents, and one (1) bedridden. At approximately 9:50 a.m. LPA and administrator tour the physical plant of the facility and the following was observed: Bedrooms: There are six (6) total bedrooms one of which is for staff use only. Five (5) bedrooms are designated for resident use one (1) of which may be shared. Bedroom are currently private. Bedrooms were observed to be properly furnished with appropriate furniture, bedding and sufficient lighting. LPA observed various hallway closets and cabinets used as storage for extra facility supplies. In one (1) of the supply closets LPA observed a fully supplied first aid kit. Auditory alarms were observed on Exit doors and were functioning properly. Bathrooms: There are three (3) bathrooms. One (1) bathroom is located in a bedroom for private use. Bathrooms were properly supplied with toilet paper, paper towels, hand soap, nonskid matts and grab bars. LPA observed night-lights in the hallway leading to the bathrooms. Hot water temperature was measured at 10:15 a.m. and read between 117 and 118.5 degrees Fahrenheit within regulation. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of two day perishable and seven day non-perishable food at the facility; properly stored. LPA observed fresh fruit and sealed snacks located at the kitchen counter and on a side table in the common area for residents. Knives and sharps were stored in a locked kitchen drawer. LPA observed cleaning supplies locked under the kitchen sink cabinet. (Continued on LIC809-C) Common Areas: These included the living rooms and dining area. The common areas were clean and clear of clutter, properly furnished. The dining room table is large enough to sit the capacity of the facility. Seating such as couches and arm chairs where in good repair and sit the capacity of the facility. A fireplace was observed off and secured with a screen. During visit LPA observed residents playing cards and scrabble. LPA observed two (2) telephones accessible to residents. Laundry and Garage: The laundry room is located in the hallway by the residents' rooms and leads to the attached garage. Laundry room was observed locked. Detergents and cleaning supplies were observed locked in the laundry room. LPA observed a freezer and a refrigerator in the garage with extra food. Surrounding Grounds: Entry/exits were free of obstructions. The outdoor patio offers shade and there was furniture appropriate for outdoor use. The outdoor area was free of hazards. There is no bodies of water on property. There are dual carbon monoxide and smoke detectors that are hard wired and interconnected. Administrator tested detectors at 10:20 a.m. and LPA observed detectors properly functioning. LPA observed sprinklers and a fire door. There are two fire extinguishers both observed fully charged with purchase date 07/12/24. Resident and Staff Files: At 10:50 a.m. LPA reviewed resident and staff files. Files are maintained locked in the staff room. LPA conducted a file review of five (5) out of five (5) resident records to insure compliance of licensing forms. LPA also conducted a file review of three (3) staff records to insure forms and training are up to date and in compliance with licensing forms. Medications: At 12:02 p.m. LPA reviewed Medication and Medication Records. LPA observed medications locked in a cabinet in the kitchen. Medications were reviewed for proper storage and documentation. Facility also uses a Medication Administration Record (MAR). Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Sep 9, 2024