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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881294
Report Date: 05/08/2023
Date Signed: 05/08/2023 11:41:53 AM

Document Has Been Signed on 05/08/2023 11:41 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:CABELLO'S RESIDENTIALFACILITY NUMBER:
331881294
ADMINISTRATOR:CABELLO, YANEDSYFACILITY TYPE:
735
ADDRESS:3277 EAGLE CREST DRTELEPHONE:
(951) 227-6007
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY: 4CENSUS: 0DATE:
05/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Cabello Yanedsy - AdministratorTIME COMPLETED:
12:00 PM
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 Licensing Program Analyst (LPA) Victoria Chitgian made an unannounced visit to conduct a Required Annual inspection. LPA met with the Administrator Cabello Yanedsy. This Adult Residential facility is licensed for four (4) ambulatory clients. LPA observed that there are currently no clients admitted to the facility. Administrator stated the facility intends to continue to be licensed however is waiting on vendorization through the Inland Regional Center.
LPA toured the facility's interior and exterior. The facility does not have any firearms or ammunition. LPA observed the facility is kept at a comfortable temperature. Hot water was measured in the bathroom at 119 degrees Fahrenheit. LPA observed the faucet and shower are operating. The client bedrooms have the required furniture and functional lighting.
LPA observed a sufficient supply of towels, linens and personal hygiene items. Cleaning supplies were observed to be locked in the laundry room. The facility’s smoke detectors and carbon monoxide detectors were tested and are in working condition.
LPA observed the kitchen to be clean and free of odor. Appliances were observed to be operating.
LPA observed where the client’s medications would be centrally located. Medication cabinet is observed to be secured and inaccessible to clients. The facility plans to have an appropriate number of staff present in the during operating hours and during the evening/sleeping hours when admitting clients in care.
LPA reviewed Administrator and facility files and observed all necessary training and certificates present, organized and complete. Signs, and required forms were seen posted in a common. The facility had a first aid kit and manual available.
The patio area is shaded and has tables and chairs for client’s comfort. The back yard is completely enclosed and revealed no immediate hazards or obstructions. The facility pool has a fenced perimeter, and is observed to be gated and locked.
No deficiencies issued per Title 22, Division 6 of the California Code of Regulations at this time.
An exit interview was conducted where this report was discussed and provided to Administrator Cabello Yanedsy.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2023
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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