Illustration — no photo of this home on file yet

Humble Haven RCFE IV

Small home·Licensed for 6·Palmdale, California

Licensed since 2022Licence #197610333
(707) 688-5606From the state roster · September 13, 2026Plan a visit
  • Care approvals on fileWheelchair · Dementia · Hospice · BedriddenState licensing record · September 13, 2026
  • Estimated starting rate$4,950 a monthCovelight estimate · likely $4,050–$6,100
  • Home sizeLicensed for 6Small care home · a licensed care home (RCFE)
  • Room at the last state visit6 of 6 beds occupiedMay 18, 2024 · not a current opening
  • Ways to payAsk the homeMedi-Cal ALW participation not on file
  • Last state visitOctober 31, 2025CDSS inspection record
  • Licence holderHumble Haven RCFE LLCSince 2022 · 4 licensed homes

Humble Haven RCFE IV is a small care home in Palmdale — a licensed residential care facility for the elderly (RCFE), the licence category behind “assisted living” and “board and care.” It is licensed for 6 residents since 2022.

Built from CDSS public records · September 13, 2026. Every fact below names its source and date.

Quick answers and the state record

A citation does not make a home unsafe, and an empty file does not make a home good.

Quick answers about Humble Haven RCFE IV

Is Humble Haven RCFE IV licensed?

The state lists this license as “Licensed,” per CDSS records as of September 13, 2026.

How many residents is Humble Haven RCFE IV licensed for?

6 residents — a small home, per CDSS records as of September 13, 2026.

Has Humble Haven RCFE IV been cited?

0 Type A and 0 Type B citations since 2022, per CDSS records as of September 13, 2026. Those records count 8 state visits over the same years.

Is Humble Haven RCFE IV still open?

This license was on the CDSS roster as of September 28, 2026.

What does Humble Haven RCFE IV cost?

$4,950 a month to start is a Covelight estimate, likely $4,050–$6,100. This home’s own rate is not on file. Ask: “What is the all-in monthly rate, and what would push it higher?”

Covelight’s estimate starts from the rates 8 small homes within 9 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.

Among 228 other homes of a similar licensed size across Los Angeles County that publish a starting rate, the middle half runs $4,000 to $6,300 a month, and the middle figure is $5,000 (n = 228 other homes publishing a starting rate).

Each of those is a home’s own published figure, gathered on its own date in September 2026 — not an average of ours, and not a survey. Similar size means small and mid-size homes counted together, and large communities counted on their own, because they are different markets.

A home outside the band is not overcharging or underpricing: a starting rate covers different things in different homes, which is the first thing to ask about.

The price is made in the phone call. Nothing here is a quote, an offer or a discount.

A starting rate is the room and the base care. California homes commonly bill care levels, medication management, supplies, transport and a second person in the room as extras. Many also charge a one-time fee at move-in. Ask for that list in writing before anything is signed.

Only prices a home put out itself count here: its own website, a listing it supplied, or a price a listing site says the home confirmed. Prices a site shows without saying where they came from are left out.

Does Humble Haven RCFE IV take Medi-Cal?

On Medi-Cal’s Assisted Living Waiver: this home is not on the DHCS participation list dated September 23, 2026. Ask the program about current options. The waiver pays for care services, not room and board.

Who holds the license?

The license is held by Humble Haven RCFE LLC, per CDSS records as of September 13, 2026. See the homes licensed to Humble Haven RCFE LLC — at least 2 on the state roster.

Is there a hospital nearby?

Palmdale Regional Medical Center is 4.3 miles away in a straight line, per the CDPH licensed-hospital list dated September 16, 2026. See licensed care homes near it.

Can Humble Haven RCFE IV keep a resident on hospice?

Hospice care is approved on this license, per CDSS records as of September 13, 2026.

Humble Haven RCFE IV license and inspection record

  • Name on the license: “HUMBLE HAVEN RCFE IV”, per the CDSS roster as of May 25, 2025.
  • License #197610333. The state lists this license as “Licensed,” per CDSS records as of September 13, 2026.
  • Licensed for 6 residents — a small home, per CDSS records as of September 13, 2026.
  • Licensed to Humble Haven RCFE LLC, per CDSS records as of September 13, 2026.
  • First licensed in 2022, per CDSS records as of September 13, 2026.
  • 8 state inspection visits since 2022, per CDSS records as of September 13, 2026.
  • 0 Type A and 0 Type B citations on file since 2022, per CDSS records as of September 13, 2026. The same records count 8 state visits in that period.
  • 1 complaint and 0 substantiated allegations on file since 2022, per CDSS records as of September 13, 2026. One complaint can carry several allegations.
  • The most recent state visit on file is October 31, 2025, per CDSS records as of September 13, 2026.
Type A citationa violation that poses an immediate risk to health, safety or personal rights if it is not correctedType B citationa violation that could become a risk if not corrected, or one involving records, resources or required services

California writes these definitions for every licensed home, not for this one. CDSS citation definitions (PDF) ↗

See the state’s own record

Can they support the care needed?

California licenses a home for specific kinds of care. The state’s record lists what this home is approved for; the home’s own answers fill in what changes as needs change.

  • Wheelchair / non-ambulatoryApproved · covers up to 5 residents
  • Dementia / memory careApproved by the state
  • Hospice careApproved by the state
  • BedriddenApproved by the state

State licensing record · September 13, 2026. An approval may cover specific rooms or residents; it does not establish an opening.

Read the state’s own wording
AGE RANGE 60 AND OVER. APPROVED FOR FIVE(5) NON-AMBULATORY AND ONE(1) BEDRIDDEN. BEDROOM #5 APPROVED FOR BEDRIDDEN CLIENTS. HOSPICE WAIVER APPROVED FOR THREE (3).

983 - RCFE / DEMENTIA

CDSS record, verbatim · September 13, 2026

As needs change

  • Staying through hospice

    Hospice waiver on file — care may continue at the end of life

    Ask: “If hospice is needed, can care continue here until the end?”

    State licensing record · September 13, 2026

  • If memory loss develops

    Dementia-care designation on file

    Ask: “Can we read the dementia care disclosure and discuss how daily support works?”

    State licensing record · September 13, 2026

3 more questions to ask the home
  • Two-person transfers or a lift

    Not on file

    Ask: “If two people or a lift are needed to transfer, can the person stay?”

  • Someone awake overnight

    Not on file

    Ask: “Who is awake overnight, and how do residents ask for help?”

  • Medicines

    Not on file

    Ask: “Who manages the medicines, and what happens when a dose is missed?”

What it costs here

Covelight estimate

$4,950a month to start

Likely $4,050–$6,100

From 8 nearby homes that publish rates · this home’s rate is not on file

Likely monthly total

$4,950a month

Likely $4,050–$6,250

With a shared room and basic help.

An estimate for planning, not a quote. The price is made in the phone call.

See the full cost breakdownRoom, care and fees · how people pay · how this estimate works
Room
Daily care
Sharing the room
  • Starting monthly rate$4,950likely $4,050–$6,100

    Covelight’s estimate starts from the rates 8 small homes within 9 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.

  • Basic help with daily careUsually includedup to $600

    Basic help is usually part of the starting rate. Homes that price care by level start around $600 a month (45 California homes publish a care-level range, seen in September 2026).

  • One-time move-in fee$2,000one time · likely $0–$4,000

    Homes that list a one-time entry or community fee charge a median of $2,000 (134 California listings; middle half $1,000–$4,000). Many homes list none — ask.

Likely monthly totalLikely $4,050–$6,250
$4,950
First monthWith a one-time move-in fee · likely $4,750–$9,350
$6,950
How people payPrivate pay, Medi-Cal waiver, SSI/SSP, veterans, insurance
  • Private payMost residents pay from savings, a home sale or family help. Ask for the rate and what it includes in writing.
  • Medi-Cal Assisted Living WaiverThis home is not on the DHCS participation list dated September 23, 2026. Ask the program about current options. The waiver pays for care services, not room and board.
  • SSI/SSPCalifornia’s 2026 standard is $1,626.07 a month; $1,444.07 of it goes to the home and $182 stays with the resident. Whether this home accepts it is not on file — ask.
  • VeteransVA Aid & Attendance can add to a veteran’s or surviving spouse’s pension. Ask whether residents here have used it.
  • Long-term care insuranceMost policies pay for licensed care homes. Ask what paperwork the home provides for claims.
  • MedicareDoes not pay for room and board in a care home. It can still cover hospice or home-health visits inside one.
If the money runs out, what Medi-Cal covers
Avoid surprises on the billWhat changes the price, and what to ask
  • The care level

    Some homes charge one all-inclusive rate. Others add levels or points as needs grow. Ask how the level is set, who decides, and what the next level costs.

  • What is billed separately

    Medication management, incontinence supplies, transportation and a second person in the room are often extra. Ask for the list in writing.

  • Move-in costs

    A one-time community fee or deposit is common. Ask what it covers and whether any of it comes back if the stay is short.

  • Increases

    California requires at least 90 days’ written notice, with reasons, before a rate rises (Health & Safety Code §1569.655). A change in the resident’s care level is the section’s own exception and can be billed sooner.

  • What is the full monthly cost for the room and care we need, and what does it include?
  • What would the next care level cost, and who decides when it changes?
  • What is billed separately, and is there a one-time fee or deposit at move-in?
  • Is any private-pay period required before another payment program can begin?
How this estimate worksWithin 25% for 7 in 10 homes in testing

Covelight’s estimate starts from the rates 8 small homes within 9 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.

8 homes like this within 9 miles publish starting rates mostly between $3,500–$4,500.

  • Only prices a home put out itself count: its own website, a listing it supplied, or a price Seniorly says the home confirmed. Prices a listing site shows without saying where they came from are left out.
  • Nearby homes are the nearest of the same size that publish a rate, widening from 3 to 40 miles until at least 8 do. The estimate starts from what they charge, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices.
  • Room, care-level, second-person and move-in lines come from what California homes publish on listing sites. Memory care uses Covelight’s researched premium over assisted living.
  • Totals add each line’s figure and combine the lines’ ranges as separate charges, because a home is rarely at the top, or the bottom, of every line at once.
  • We tested this estimate on 1,546 California homes that publish their own starting rate. It was within 10% of the real rate for 3 in 10 homes and within 25% for 7 in 10; the likely range held the real rate for 6 in 10 (September 12, 2026).
  • It cannot see this home’s specials, how it assesses care, or which rooms are open.
Show the 8 nearby homes behind this estimate

Where it is

  • 4036 Tournament Drive, Palmdale, CA 93551Address from the public record · September 13, 2026. Confirm the entrance with the home before visiting.

Opening the neighborhood map…

The state record

California inspects every licensed home and publishes what it found. Here are the dated documents and the state’s own words, beside what is typical for homes this size.

Since 2022, the state has filed 8 documents for this home, and its records count 8 visits since 2022. The most recent is a facility evaluation report, dated October 31, 2025.

On file since
2022
State visits
8
Most recent visit
October 31, 2025
Occupied · May 18, 2024 visit
6 of 6 bedsa count on that day, not an opening

We hold 1 complaint report the state published for this home, dated May 18, 2024. 1 of the 1 carries the state's recorded outcome word: “Unsubstantiated” (1). 1 includes the transcribed allegation the state investigated, word for word. Summary composed by computer from the 1 complaint report below — every count derives from them, and the documents themselves are the state's records, verbatim. We never grade, score, or color a record.

Beside homes the same size

  • Type A citations0typical 0
  • Type B citations0typical 0
  • Substantiated allegations0typical 0
  • Total complaints1typical 0

“Typical” is the statewide median across the 6,808 licensed small board-and-care homes (6 or fewer beds) in the state record — larger, longer-licensed homes accumulate more visits and reports, so compare like with like. One complaint can contain several allegations. Counts cover this licence since 2022.

Year by year
YearVisitsDocumentsSubstantiated202511020244502022220

The last 36 months — 6 of 8 documents

The full record on the state’s site →
20251 state visit · 1 document
Oct 31, 2025Facility evaluation reportReport on file

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit on 10/31/2025 and was greeted by two caregivers. LPA stated the purpose of the visit was to conduct an annual inspection. The caregivers confirmed there are four residents. The facility is licensed for five (5) non-ambulatory residents and one bedridden resident. LPA reviewed the resident files at 9:15 am until 9:45 am. LPA observed three out of four residents' files were missing documentation. LPA Spaeth and the caregivers toured the facility at 10:00 am until 10:45 am Common Areas – The family room, dining room, and kitchen are combined. The family room was furnished with comfortable seating and a television. The dining room area contained a dining room table and chairs. Kitchen - LPA Spaeth observed a two-day supply of perishable food and a seven day supply of non-perishable food. The knives were locked. The cleaning solutions were locked underneath the kitchen sink. The fire extinguisher is located near the kitchen and is operable. Medications: LPA observed the resident medications, first aid kit, and PPE supplies were safely locked in a kitchen cabinet. Continued on 809-C Resident Rooms: The resident rooms were furnished with a bed, linens, night stand, lamp and chair. Bathrooms: The bathrooms contained hand soap, paper towels, grab bars, trash can, and slip resistant mats. Laundry Room & Staff Room: LPA observed the laundry room door was not locked and the laundry detergent, washer and dryer were in the room. Another door led to the garage and staff room and that door was not locked. LPA observed tools were laying on the garage floor and were not locked in a secure area. LPA reminded staff the door leading to the laundry room should be locked at all times. Water Temperature: The water temperature was tested at 10:20 am and was 112 Degrees F. Hallway Cabinet- LPA observed the clean linens were located in a cabinet. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. The side gate of the house was closed and was not locked. Comfortable seating is also located in the backyard in a shaded area Smoke/Carbon Monoxide Detectors: The smoke and carbon monoxide detectors were tested 10:45 am and were operable. LPA Spaeth reviewed the staff files at 10:45 am until 11:15 am. LPA reviewed the medications at 11:15 am until 11:30 am. Based upon Title 22 Division 6 of the CA Code of Regulations, the following deficiencies are issued (See 809-D). Exit interview conducted, appeal rights were discussed, and a copy of the report was given.the state’s words, verbatim · CDSS document, Oct 31, 2025
20244 state visits · 5 documents
Nov 1, 2024Facility evaluation reportReport on file

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit on 11/01/2024 and was greeted by the caregiver. The Administrator Nicole De Las Alas was called. LPA stated the purpose of the visit was to conduct an annual inspection. The caregiver confirmed there are five residents. The facility is licensed for five (5) non-ambulatory residents and one bedridden resident. LPA Spaeth and the caregiver toured the facility at 10:00 am until 10:30 am. Common Areas – The family room, dining room, and kitchen are combined. The family room was furnished with comfortable seating and a television. The dining room area contained a dining room table and chairs. Kitchen - LPA Spaeth observed a two-day supply of perishable food and a seven day supply of non-perishable food. The knives were locked. The cleaning solutions were locked underneath the kitchen sink. The fire extinguisher is located near the kitchen and is operable. Medications: LPA observed the resident medications, first aid kit, and PPE supplies were safely locked in a kitchen cabinet Continued on 809-C Resident Rooms: The resident rooms were furnished with a bed, linens, night stand, lamp and chair. At 10:20 am, LPA observed there are two residents in the Bedroom 5. LPA also observed an additional empty bed was located in the room and was blocking part of the doorway leading in and out of the room. At 10:35 am, LPA spoke to the Licensee, Nicole De Las Alas and stated the bed needs to be removed as soon as possible. During LPA's visit, the additional bed was removed at 11:00 am Bathrooms: The bathrooms contained hand soap, paper towels, grab bars, trash can, and slip resistant mats. Water Temperature: The water temperature was tested at 10:25 am and was 130 Degrees F. The water heater temperature was lowered. LPA tested the water temperature again at 11:09 am and the temperature was 115.0 degrees F. Hallway Cabinet- LPA observed the clean linens were located in a cabinet. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. The side gate of the house was closed and was not locked. Comfortable seating is also located in the backyard in a shaded area Smoke/Carbon Monoxide Detectors: The smoke and carbon monoxide detectors were tested at 11:30 am and were operable. LPA Spaeth reviewed the resident files at 10:45 am until 11:07 am and reviewed the staff staff files at 11:07 am until 11:20 am. LPA reviewed the medications at 11:30 am until 11:55 am. Based upon LPA's observations, the following deficiencies were issued. Exit interview conducted, appeal rights were discussed, and a copy of the report was given.the state’s words, verbatim · CDSS document, Nov 1, 2024
May 18, 2024Complaint investigation reportUnsubstantiated

Allegation investigated: Staff does not provide adequate food service to residents in care.

On 05/18/24, Licensing Program Analyst (LPA) Ernand Dabuet made subsequent unannounced visit to this facility and was greeted by caregiver staff #1 Jasmin Bihasa. LPA Dabuet contacted the administrator Nicole De Las Alas who was not available for this visit. LPA explained the purpose for today’s visit is to gather information for the allegation mentioned above and deliver findings. The investigation consisted of the following: An initial 10-Day visit was conducted by (LPA) Melissa Spaeth who met with Albert Gonzalez. (LPA) requested copies of files for resident #1 (R1’s) ID and Emergency Information, Admissions Agreement (dated: 08/03/23), Physicians Report LIC 602A (dated: 07/14/23), Preplacement Appraisal Information LIC 603 (dated: 12/20/21), Register of Facility Residents LIC 9020 (dated: 09/10/23) and Facility Roster, Facility Weekly Menu, and Photos Food Supply (dated: 05/17/24). A review of residents #2-#6 (R2-R6)’s service files. Interviews conducted with residents #1-#6 (R1-R6), staff #1-#3 (S1-S3), and witness #1-#3 (W1-W3). A tour of the facility was performed. (Evaluaiton Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Staff does not provide adequate food service to residents in care. The details of the complaint reported the facility staff does not provide adequate food service to residents in care. The complainant reported resident#1 (R1) is not being fed lunch and healthy and sufficient food. Furthermore, the facility is also not following the meal regulations when dinner time is too early and no snacks. The Department conducted an inspection visit on 07/06/23, 05/17/24, and 05/18/24 and observed the facility is following Title 22 Section 87555 General Food Service Requirements. The Department observed food supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. The food supply included milk products, meat, vegetables, fruits, bread, cereals, juices, and desserts. A weekly menu was posted and made available for review for residents. On 05/17/24, between 11:16 am – 11:31 pm, the Department interviewed resident #1 (R1). (R1) confirmed the facility served three meals daily with snacks. (R1) stated the facility provided adequate food portions and a variety. (R1) stated (R1) preferred not having in-between meal snacks as meal portions are sufficient. (R1) claimed (R1) had to be mindful of gaining weight. (R1) reported not having issues with meals being serviced at breakfast at 8 am, lunch at noon, and dinner at 6 pm. On 05/17/24, between 11:32 am – 11:55 am, the Department interviewed (5) out of (5) residents #2 - #6 (R2-R6) who were complimentary of staff. (R2-R6) reported that they were provided with three meals and snacks and that the portion sizes were adequate. (R2-R6) reported the meals were satisfactory and were served at proper mealtimes. On 05/17/24, between 11:56 am – 12:21 pm, the Department interviewed (3) out of (3) staff #1 - #3 (S1-S3) reported that groceries are restocked every week. (Evaluation Report continues LIC 9099-C) (S1-S3) reported following the weekly menu plan and portion sizes. The services of meals as indicated on the plan with breakfast 8:00 am – 9:00 am, lunch 12:00 pm – 01:00 pm, and dinner 5:00 pm – 6:00 pm are followed. In between refreshments are provided to all residents in care according to (S1-S3). On 05/17/24, between 02:32 pm and 03:55 pm, the Department interviewed (3) out of (3) witnesses #1-#3 (W1-W3). Two (2) out of (3) three verified having no issues with the facility's food meals or services. (W1) cited being very pleased with the management and staff at this facility, and the care and services provided were excellent. As a result of the Department reviewing (R1-R6)'s Physician Report LIC 602A, it revealed that (3) out of (6) are not required to be on any dietary restrictions, while the other three are on a mechanical soft diet. Based on the gathered information, the allegation mentioned above cannot be supported. Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited. An exit interview is conducted with Jasmin Bihasa and a copy of the report is provided.the state’s words, verbatim · CDSS document, May 18, 2024 · control 31-AS-20230703082026
May 18, 2024Facility evaluation reportReport on file

Type of visit: Case Management - Deficiencies

On 05/18/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted a case management inspection visit at this facility. LPA met with caregiver Jasmin Bihasa and explained the purpose of the visit is in association with a complaint investigation conducted on 05/17/24 and 05/18/24. During the investigation visit on 05/17/24, LPA Dabuet audited the staff files and identified staff #3 (S3) did not have a Criminal Clearance Background Clearance Transfer. (S3) was not associated at this facility when the facility was approved to operate with a Community Care Licensing (CCL) on 11/01/22. (S3) did not appear in (CCLD) Guardian nor Licensing Information System (LIS536). The licensee is being cited with Title 22 Criminal Clearance Record Regulations 87355(e)(2). Based on interviews, observation, and record reviews the licensee violated the California Code Regulations (CCR) of Title 22, Division 6, Chapter 8. Deficiency is issued and an exit interview is conducted with (Jasmin Bihasa) . A copy of this report, appeal rights, and civil penalty were provided. *Immediate Civil Penalty*the state’s words, verbatim · CDSS document, May 18, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: May 19, 2024

87355 Criminal Record Clearance - (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement is not met as evidenced by: Based on audit review of records, the licensee did not comply with the section. LPA identified staff #3 did not have a Criminal Clearance Background Clearance Transfer associated at this facility. This violation poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 18, 2024

Plan of correction: Licensee to ensure that all staff prior to working in the facility obtain a Criminal Background Clearance and Criminal Background Transfer Request and provide proof of correction to CCLD by POC due date. Proof of Correction due date: 05/19/24 to ernand.dabuet@dsss.ca.gov *A CIVIL PENALTY IS BEING ISSUED TODAY 05/18/24*

May 17, 2024Facility evaluation reportReport on file

Type of visit: Case Management - Deficiencies

On 05/17/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted a case management inspection visit at this facility. LPA met with caregivers Jasmin, Joselito, and Jennifer Bihasa and explained the purpose of the visit. During a complaint investigation visit on 05/17/24, LPA Dabuet was informed that (4) out of (6) residents are in hospice care. The residents on hospice are (R1), (R2), (R4), and (R5). The facility is approved by the Community Care Licensing Department (CCLD) for (3) hospice residents. The licensee shall not operate a facility beyond the conditions and limitations specified on the license. On 05/17/24, between 11:15 am - 11:35 am, LPA Dabuet reviewed staff files and observed that staff #2 and #3 had no current First Aid/CPR certificate for training. (S2-S3) communicated that they have not renewed their required training for First Aid/CPR. Based on interviews, observation, and record reviews the licensee violated Title 22 Regulations. California Code of Regulations (Title 22, Division 6, Chapter 8), deficiencies were observed, and citations were issued (ref. LIC 9099-D). An exit interview was conducted and a copy of the Evaluation Report and Appeal Rights were provided to Jasmin Bihasa. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *the state’s words, verbatim · CDSS document, May 17, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87204(a) · Plan of correction due date: May 31, 2024

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time... An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by: Based on [(observation) (interview) (record review)], the licensee did not comply with the section. The facility is approved for (3) hospice waiver and is now operating with (4) hospice residents beyond the conditions and limitations specified on the license. This violation which poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 17, 2024

Plan of correction: Licensee agreed to request for hospice waiver increase request to CCLD by correction date 05/31/24 understands that it is their responsibility to follow up on waiver requests and hospice residents should not reside at the facility until a hospice waiver is granted by CCL. Plan of correction must be submitted by 05/31/24 to ernand.dabuet@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c)(1) · Plan of correction due date: May 31, 2024

(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: Based on record review, the licensee did not comply with the section cited above . LPA identified staff #2 & #3 did not have a current First Aid/CPR Training. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 17, 2024

Plan of correction: Licensee/Administrator will ensure that all staff involved with resident's daily care must have a current First Aid/CPR training. Proof of correction must be sent to by POC due date: 05/31/24 to ernand.dabuet.@dss.ca.gov

Mar 22, 2024Facility evaluation reportReport on file

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by two caregivers (S1 and S2). LPA observed a third person and was informed it was a family member of the two caregivers. Upon entry at 9:15 am, LPA observed the delayed egress notification was not working at the front door. LPA stated the purpose of the visit was to conduct an annual inspection. The staff confirmed there are six residents. The facility is licensed for five non-ambulatory residents and one (1) bedridden resident. LPA Spaeth reviewed resident records at 10:00 am to 11:00 am. LPA Spaeth & caregiver toured the facility at 11:00 to 11:30 am. Living Room. - When entering the facility, the living room is located to the right and is a room with three walls. LPA observed a curtain was used as a door. LPA observed the room is used as a staff room and contained two twin beds. At 9:30 am, LPA observed staff member's medication was sitting out on a dresser. At 9:33 am, LPA observed the caregiver locked the medication in the resident's medication cabinet. Kitchen/Family Room - LPA Spaeth observed the kitchen and family room are combined. The facility contained a two day supply of perishable food and a seven day supply of non-perishable foods. The knives were locked in a kitchen cabinet. The cleaning solutions are securely locked underneath the kitchen sink. The fire extinguisher is located in the kitchen and is operable. Medication - LPA observed the resident medications, and first aid kit, are safely locked in a kitchen cabinet. The resident and staff files were also locked in the cabinet. Delayed Egress: LPA observed the delayed egress to all exits were turned off and not working. Continued on 809-C Garage//Washer & Dryer – The laundry room was locked and contained the washer/dryer. The laundry soap was stored in the room. The door leading to the garage was locked. at 11:40 am, LPA observed a section of the garage was converted into a room. LPA observed a bed, microwave, portable toilet, and a person's belongings. There is an exit out of the room to the front yard. The caregivers stated a person is renting the room. They also stated the individual uses the portable toilet at night but will go through the front door to use the restroom and shower during the day. The caregivers confirmed the resident does not receive care and supervision. Resident Rooms: The resident rooms were furnished with a bed, linens, night stand, lamp and chair. Based upon the Fire Safety Inspection Request document issued by the Los Angeles Fire Department which was dated 9/2022, the facility may have five non-ambulatory residents and one bedridden resident. Bedrooms 1, 2, 3, and 4 are non-ambulatory rooms. Bedroom 5 is the designated bedridden room. LPA observed two bedridden residents living in Bedroom 1 (one) and Bedroom 3 (three). Bathrooms: The bathrooms contained hand soap, paper towels, grab bars, trash can, and slip resistant mats. When observing bathroom two, LPA observed cleaning solutions were unlocked underneath the sink. LPA observed the caregiver moved the solutions to a locked cabinet. Water Temperature: LPA tested the water temperature at 11:45 am which was 141.1 degrees F. LPA instructed the caregiver to adjust the water temperature to the hot water heat. LPA observed the caregiver did turn the temperature at 11:50 am. Contd' 809-C Surrounding Grounds: The backyard contained comfortable seating. LPA observed a spa is located in backyard. The spa cover was only cover one quarter of the spa. There was no water in the spa but a portable step was located next to the spa which allows access into the spa. Smoke/Carbon Monoxide Detectors: The smoke/carbon monoxide detectors were tested at 11:55 am. Based upon Title 22 Regulations, the following deficiency is substantiated. (See 809-D page). LPA Spaeth read the report to the Administrator, Nicole De Las Alas at 3:00 pm until 3:15 pm. The Administrator stated to LPA Spaeth that the caregiver may sign the report. LPA Spaeth also informed the Administrator that an additional unannounced visit may be warranted to address the staff living in the living room area. Exit interview was conducted, appeal rights discussed, and a copy of the report was given.the state’s words, verbatim · CDSS document, Mar 22, 2024
What the state’s words mean
Substantiatedthe state found the allegation more likely true than notUnsubstantiatedthere was not enough evidence to prove a violation occurred — not a finding of wrongdoingUnfoundedthe evidence showed the allegation was false, could not have happened, or had no reasonable basisType A citationa violation that poses an immediate risk to health, safety or personal rights if it is not correctedType B citationa violation that could become a risk if not corrected, or one involving records, resources or required services

CDSS citation definitions (PDF) ↗ · CDSS complaint outcomes ↗

An “unsubstantiated” complaint is not a finding of wrongdoing — it means the state investigated and could not confirm the allegation. Outcome words are the state’s own; we never grade, score, or color a record, and we publish no reviews — the state’s dated documents and the questions below stand in their place.
Open CDSS facility search ↗Report a record errorOperate this home? Respond or correct, free →

Who holds the licence

Humble Haven RCFE LLC, licensed since 2022, operates 4 licensed homes in California. Running more than one home is common and is neither good nor bad on its own.

Life here

Rooms, meals, the rhythm of a day, faith and language, pets and house rules — as the home describes them. Tap any detail for its source and date; nothing here is graded.

The home has not described daily life anywhere we have reviewed yet — that is the case for most small homes, and it says nothing about the home. These questions fill in the picture; keep the ones that matter to you.

Before you call

Ask every home the same questions — the state’s record does not answer these. Keep the ones that matter and they travel with your saved homes.

  1. What is included in the monthly rate, and what costs extra?
  2. Who is awake overnight, and how do residents ask for help?
  3. Which rooms does the non-ambulatory approval cover, and what transfer support is provided?
  4. What could change whether someone can stay here?
  5. Can we see a bedroom and share a meal during a visit?
Print a visit sheetCompare saved homesOpen saved homes

Other homes nearby

The nearest licensed homes in Los Angeles County, closest first. Every listed home appears on the same terms.

Club Vista Care Home

Palmdale · Small home · 0.2 mi away

$5,000 a month to start · Covelight estimate

WheelchairDementiaHospiceBedridden

Fairway Vista

Palmdale · Small home · 0.5 mi away

$5,000 a month to start · Covelight estimate

WheelchairDementiaHospiceBedridden

4 Aces Elderly Care

Palmdale · Small home · 0.5 mi away

$5,150 a month to start · Covelight estimate

WheelchairDementiaBedridden

Club Rancho Manor

Palmdale · Small home · 0.5 mi away

$4,000 a month to start · Listed by the home

WheelchairHospiceBedridden

Annabelle's Cottage

Palmdale · Small home · 0.7 mi away

$4,250 a month to start · Covelight estimate

WheelchairDementiaBedridden

The Providence Manor

Palmdale · Small home · 0.8 mi away

$4,800 a month to start · Covelight estimate

WheelchairDementiaHospiceBedridden
Explore Los Angeles County
CallPlan a visit