331881294-5-2-2022-56-AS-MBRN-CE2VF2-20220502162313

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881294
Report Date: 05/02/2022
Date Signed: 05/02/2022 04:23:36 PM

Document Has Been Signed on 05/02/2022 04:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME:	CABELLO'S RESIDENTIAL		FACILITY NUMBER:	331881294
ADMINISTRATOR:	CABELLO, YANEDSY		FACILITY TYPE:	735
ADDRESS:	3277 EAGLE CREST DR		TELEPHONE:	(951) 227-6007
CITY:	CORONA	STATE: CA	ZIP CODE:	92881
CAPACITY: 4		CENSUS: 0	DATE:	05/02/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator/Applicant Yanedsy Cabello		TIME COMPLETED:	04:35 PM

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Licensing Program Analyst (LPA) Melody Brown conducted an announced visit 05/02/2022 at 2:00 PM to the facility for a pre-licensing inspection. LPA Brown met with Administrator/Applicant Yanedsy Cabello.

This facility was previously licensed as Cabello Family Childcare and Facility Number: 334844203 and currently is undergoing a change of facility type. The pending application is for a capacity of four (4) ambulatory clients in an Adult Residential Facility for (ARF).

Fire clearance was granted by the City of Corona of the Fire Marshall for four (4) ambulatory clients. There are four (4) charged fire extinguishers, operating eight (8) dual smoke alarms and carbon monoxide detectors. Emergency disaster plans, personal rights, and the Community Care Licensing poster were posted in a prominent area. The facility was equipped with a complete first aid kit and manual as well as emergency supplies.

LPA Brown toured the facility inside and out. The following was observed, reviewed, and inspected:

The facility has 6 bedrooms, in which four(4) bedrooms are designated for clients and (one) 1 bedroom is designated for staff/office and one (1) isolation room, 3 bathrooms, living room, kitchen, dining area, backyard, and attached garage.

The physical plant, in general, was in good repair. The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. LPA Brown observed an in-ground pool in the backyard, the perimeter of pool is gated and locked. LPA Brown inspected the backyard. There was a shaded area with seating. There was no obstruction on the side yard exits. The gates remained unlocked.

LPA Brown was informed that no firearms or ammunition will be kept at the facility. The Administrator/Applicant has a current Administrator's Certificate with an expiration date of July 8, 2023..

(continuation on LIC809C)

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: CABELLO'S RESIDENTIAL	FACILITY NUMBER: 331881294
	VISIT DATE: 05/02/2022

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LPA Brown inspected client bedrooms. Client bedrooms have the required bedding and furniture. All bedrooms included clean mattresses, closet space, nightstands, dressers, and sufficient lighting. LPA Brown inspected Client bathrooms. The bathrooms were operating in safe and sanitary conditions. LPA Brown measured the hot water temperature, which measured within regulation at 105 degrees F. LPA Brown also observed additional linen and hygiene items for the clients. LPA Brown toured the kitchen. The facility had a three (3) day supply of perishable food items and seven (7) day supply of non-perishable food items. The foods were stored in a safe and healthful manner. The facility had a menu available for review. Dishes, glasses, and utensils were in good condition.

There was a locked and centralized storage area for medications. Cleaning supplies, toxins, and sharps were kept locked away and inaccessible to clients. Additionally, LPA Brown observed facility to have required single entry point for COVID screening, upon entering the facility. LPA Brown observed required COVID signages throughout the facility, Visitation Vaccination Requirement and soap and paper towels in bathrooms for washing hands.

The facility had a designated area for client and staff files, which was locked. The facility has a working telephone for clients’ use. There was adequate seating in the common areas. LPA Brown observed activities for the clients such as books and board games.

At this time facility has shown to have met pre-licensing requirements.

The facility was evaluated in accordance with the California Code of Regulation (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of clients in care. Based on the observations and evaluation of the facility this date, the facility’s ready for licensure.

Administrator/Applicant will be notified once facility is licensed.

An exit interview was conducted, and a copy of this (LIC809) was discussed and provided to Administrator/Applicant Yanesdsy Cabello.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

LIC809 (FAS) - (06/04)

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