Senior Care Records.

Facility Evaluation Report

White Box Lane Home LLC, Moreno Valley12/05/2025Licence 331881502

Capacity6
Census5
Date signed12/10/2025 12:35:55 PM
Name of licensing program analystValerie Flores
Name of licensing program managerAnthony Perez
The inspector’s account

On 12/5/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of launching the complaint investigation into complaint 18-AS-20251201214149. LPA met with Administrator May Embalsado and explained to May the purpose of the visit.

Through file review, LPA learned that Client #1 (C1) did not receive a completed medical assessment prior to being retained at the facility nor was an assessment obtained which violates Title 22 Regulations Section 80069(b). Therefore, a deficiency will be issued during today's visit.

An exit interview was conducted and a copy of this report was provided to Administrator May.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction