Small board & care homeLicensed

Angel 1004 Residential Home

Licensed for 6 residents
Serves residents with dementia
Hospice waiver

About Angel 1004 Residential Home

Angel 1004 Residential Home is a small, home-like residential care facility for the elderly in Fontana, California, licensed by the California Department of Social Services to care for up to 6 residents. CDSS lists it as serving residents with dementia. It holds a hospice waiver, so residents can receive hospice care without moving.

Licensing & inspections

Official CDSS report

License status: Licensed
Facility number: 365530434
Licensed capacity: 6
Licensed since: February 27, 2026
Last state visit: February 19, 2026
Inspection visits: 0; Recent routine and required inspections
Complaint visits: 0; Visits to investigate complaints
Type A citations: 0; Immediate risk to health, safety, or rights
Type B citations: 0; Could become a risk if not corrected

Licensee:: 1004 Care LLC
Administrator:: Kim, Haejin
CDSS office:: SAN BERNARDINO ASC
Serves:: RCFE / Dementia

State license notes: Age range 60 and over. Approved for six(6) non-ambulatory residents, of which one(1) may be bedridden in bedroom #2. Waiver/granted for hospice care for (2) residents.

Data from CDSS Community Care Licensing, last checked November 3, 2026.

Location

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