Pre-licensing visit·October 2, 2025

Licensing Program Analyst (LPA) Beena Singh conducted an announced visit to the facility for purpose of Pre licensing evaluation. LPA Singh met with Facility Administrator Israel Cabrerros. A change of ownership (CHOW) application to operate Residential Care Facility for Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 03/22/2025, for a total capacity of six (6), five Non-Ambulatory and one (1) Bedridden. Fire clearance was granted on 04/25/2025. LPA Singh observed the following: Structure: Facility is a two (2) story house downstairs with four (4) residents bedrooms ,three bedrooms -one(1) bathroom upstairs for staff and two (2) and 1/2 bathrooms downstairs, living room, dining area and kitchen. There was an attached two (2) car garage on the right side of the house. Heating/Cooling System: Central heating and air conditioning system installed with one (1) central panel located in the hallway to control entire house. Bedrooms: Each client bedrooms accommodate any non-ambulatory residents. All residents bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, a lamp and an operable smoke/carbon monoxide alarm. Bathrooms: The two (2) and 1/2 resident bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. LPA Singh tested the water temperatures in the clients' bathrooms. LPA Singh verified water temperature was measured at 119 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA Singh observed the stove to be operational. Refrigerator/freezer were in working condition. There is sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was in the laundry room and laundry detergents and cleaning supplies were observed in the laundry in a locked cabinet. Garage door is locked away from residents. Living/Family room: There was a living/family room with adequate seating for all clients and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the hallway of the residence. Yards/Outside: Patio furniture for outdoor seating observed. Self-latching handle gate on left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch was observed posted near the main entrance. There was Let-Us-No poster and Labor Laws observed. General items: One (1) fire extinguisher was charged and located in the pantry. Three (3) combined smoke detectors and carbon monoxide detectors were tested and were observed to be in working order. Client records and staff records will be stored in a locked cabinet in the hallway. First Aid kit with required components, and locked area for medication storage was observed. LPA Singh observed a facility phone and the phone number designated for the facility is 951-256-1356. Liability insurance dates valid through 07/01/2025-07-01-2026. There is enough Emergency water supply and the required 72 hour emergency food supply for clients and staffs available at the facility. Component III was completed on this day as well. Additionally, LPA Singh observed facility having Visitor Sign In/Sign Out Sheet and Client Sign In/Sign Out Sheet, upon entering facility. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of clients in care. Facility appears to be ready for licensure. An exit interview was conducted, and a copy of this report, LIC 809 was discussed and provided to Applicant/Administrator Facility Administrator Israel Cabrerros.