361880919-8-20-2026-56-AS-NBRN-DXCQ3C-20260827114832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880919
Report Date: 08/20/2026
Date Signed: 08/20/2026 03:23:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/26/2026 and conducted by Evaluator Becky Mann

COMPLAINT CONTROL NUMBER: 56-AS-20260126093655

FACILITY NAME:	LOVE 2 CARE HOMES		FACILITY NUMBER:	361880919
ADMINISTRATOR:	JACKSON, TERRI		FACILITY TYPE:	740
ADDRESS:	19432 US HIGHWAY 18		TELEPHONE:	(760) 297-6277
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92307
CAPACITY:	6	CENSUS: 5	DATE:	08/20/2026
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Jasmine Goudeau, Caregiver		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Due to staff negligence, resident was injured
Staff did not ensure resident had clean linens
Staff did not ensure residents room was cleaned properly
Staff did not report incident to authorized representative
Staff did not provide all medications to authorized representative when resident moved

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA Mann met with Jasmine Goudeau, Caregiver and explained the purpose of today's visit. The investigation consisted of LPA observations, pertinent document reviews, and interviews with staff and residents.
The allegation that Due to staff negligence, resident was injured. Two (2) staff interviewed denied staff negligence that resulted in a resident being injured. Resident #1 (R1) and Resident #2 (R2) interviewed denied of staff negligence and have not been injured at the facility. Attempts to interview Resident #3 (R3) and Resident#4 (R4) were made; however, they were unable to provide information.

The allegation that Staff did not ensure resident had clean linens. Two (2) staff interviewed stated that they clean the linens often. Based on LPA observations, residents’ linens are clean. R1 and R2 stated that the staff do keep their linens clean. Attempts to interview R3 and R4 were made; however, they were unable to provide information.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20260126093655

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: LOVE 2 CARE HOMES	FACILITY NUMBER: 361880919
	VISIT DATE: 08/20/2026

NARRATIVE

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The allegation that Staff did not ensure residents room was cleaned properly. Two (2) staff interviewed stated that they clean the residents’ room daily. Based on LPA observations, the residents’ rooms are clean. R1 and R2 stated that the staff do clean their rooms daily. Attempts to interview R3 and R4 were made; however, they were unable to provide information.

The allegation that Staff did not report incident to authorized representative. Two (2) staff interviewed stated that they report incidents to the administrator. Interviews with R1 and R2 did not reveal enough evidence to corroborate the allegation. Attempts to interview R3 and R4 were made; however, they were unable to provide information.

The allegation that Staff did not provide all medications to authorized representative when resident moved. Two (2) staff interviewed stated that they do provide all medications to authorized representatives when a resident moves out of the facility. R1, R2, R3 and R4 currently resides at the facility and have not moved out.

Based on interviews with staff and residents, the allegations above are Unsubstantiated; meaning that 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.

An exit interview was conducted where this report was discussed and a copy of this report was provided to Jasmine Goudeau, Caregiver at the conclusion of the visit.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

LIC9099 (FAS) - (06/04)

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