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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881301
Report Date: 07/20/2026
Date Signed: 07/20/2026 07:33:00 PM

Document Has Been Signed on 07/20/2026 07:33 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:A DRESSAGE HOME CAREFACILITY NUMBER:
331881301
ADMINISTRATOR/
DIRECTOR:		LABASTIDA, ROMEO G.FACILITY TYPE:
740
ADDRESS:12029 DRESSAGE LANETELEPHONE:
(951) 751-5875
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY: 6CENSUS: 5DATE:
07/20/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Romeo/Anita Labstida, LicenseeTIME VISIT/
INSPECTION COMPLETED:
07:50 PM
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Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry by Susan Romero. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Susan contacted Licensee Romeo Labastida by telephone and LPA advised of the visit. Licensees arrived at the end of the inspection.

Resident record review began- Five (5) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements.

Employee records review began- Three (3) records were reviewed. LPA reviewed employee record for first aid certification - 1 missing, fingerprint clearance, personnel/job application, health screening and TB test results, training verification-1 missing, and a current administrator certification was requested and not provided. CPR-1 missing and requirements have not been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Corporation or LLC is active and in good standing.


Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside-the exterior gate door latch had a metal wire wrapped around the latch to prevent from opening and closing, an exterior window screen was observed torn. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 115.0 degrees F.


(Continued on LIC809, Page 2)
Anthony Perez
Yolanda Delgado
DATE: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: A DRESSAGE HOME CARE
FACILITY NUMBER: 331881301
VISIT DATE: 07/20/2026
NARRATIVE
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(Continued from LIC809, Page 1)

Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location.

Food Service- Food supply meets the of one week supply of nonperishable and 2-day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized; however a black 4 inch strips were observed on both door to refrigerator that latches when placed together.

LPA made observations throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations - flip action door lock was observed on the interior front door, . The facility has not exceeded its capacity limitation, and the structure remains unchanged however there has been changes to the floor plan according to the approved floor plan-2 resident rooms were observed with two beds instead of 1, full bed rails were observed on two hospital beds occupied by residents that are are not on hospice, Resident shared bedroom #4 is being occupied by live-in staff, Resident (private) room #2 is being occupied by a resident and a staff member sleeps at night in the room. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers were tested or replaced on 04/18/2024-Not current. The facility conducting emergency disaster drills quarterly; last done 5/10/2026. A referral for TSP will be submitted on behalf of the Licensees.

Based on the information received during this visit today, there seven (7) deficiencies with Civil Penalties for $500 is being cited and issued per Title 22, Division 6 of The California Code of Regulations.

This report, LIC809D, LIC421IM, Appeal Rights was reviewed with Anita Labastida and copies provided at the time of the exit interview.

LPA has requested updates to the following documents to be submitted to the CCL by 07/27/2026: LIC 500, LIC200 with updated facility sketch.
NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Yolanda Delgado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 07/20/2026 07:33 PM - It Cannot Be Edited


Created By: Yolanda Delgado On 07/20/2026 at 05:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: A DRESSAGE HOME CARE
FACILITY NUMBER: 331881301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(c)
Maintenance and Operation
(c) All window screens shall be clean and maintained in good repair.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Delgado's observation and interview, the licensee did not comply with the section cited above in one (1) exterior window screen is torn which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2026
Plan of Correction
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Licensee will replace window screen and ensure all window screens remain in good repair at all times, emailed an invoice or picture of repaired screen to LPA by POC due date.
Type B
Section Cited
CCR
87303(i)(1)(B)
Maintenance and Operation
(i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Delgado's observation and interview, the licensee did not comply with the section cited above in resident room #2, #6 door alarms did not activate with any type of sound when door was opened which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2026
Plan of Correction
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Licensee will ensure that door alarms are activated and working at all times and implement a door alarm check log and email to LPA by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Anthony Perez
NAME OF LICENSING PROGRAM MANAGER:
Yolanda Delgado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2026


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 07/20/2026 07:33 PM - It Cannot Be Edited


Created By: Yolanda Delgado On 07/20/2026 at 05:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: A DRESSAGE HOME CARE
FACILITY NUMBER: 331881301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)(13)(B)1
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 1. For Certified Administrators, a copy their current and valid Administrative Certification meets this requirement.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Delgado's observation, interview and record review, the licensee did not comply with the section cited above in a copy of current and valid Administrative Certification was not observed, requested and not provided which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2026
Plan of Correction
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Licensee will obain a copy and ensure a current and valid Administrator Certificate is posted at all times in the facility and email a copy to LPA by POC due date.
Type B
Section Cited
CCR
87412(d)
Personnel Records
(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Delgado's observation, interview and record review, the licensee did not comply with the section cited above in file review of Administrator, there was no documentation that administrator met the recertification requirements which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2026
Plan of Correction
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Licensee will ensure documentation is maintained in Administrators file and is able to be viewed at any given time by the Department, copies of documenation for recertification will be emailed to LPA by POC Due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Anthony Perez
NAME OF LICENSING PROGRAM MANAGER:
Yolanda Delgado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2026


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 07/20/2026 07:33 PM - It Cannot Be Edited


Created By: Yolanda Delgado On 07/20/2026 at 05:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: A DRESSAGE HOME CARE
FACILITY NUMBER: 331881301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87608(a)(5)(B)
Postural Supports
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Delgado's observation, interview and record review, the licensee did not comply with the section cited above in Resident #1 and Resident #2 had full rails on hospital beds and no documentation of being under Hospice Care was requested and not provided which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/03/2026
Plan of Correction
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Licensee will remove full rails from identified residents beds by POC due date. Licensee will ensure that hospice plan is abided at all times, email picture of beds to LPA by POC due date unless hospice plans for the identified residents is provided in completion according to the approved hospice waiver.
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Anthony Perez
NAME OF LICENSING PROGRAM MANAGER:
Yolanda Delgado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2026


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 07/20/2026 07:33 PM - It Cannot Be Edited


Created By: Yolanda Delgado On 07/20/2026 at 05:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: A DRESSAGE HOME CARE
FACILITY NUMBER: 331881301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
87203
OPERATING REQUIREMENTS:
87203 Fire Safety All facilities shall be maintained in comformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA Delgado's observation, interview and record review, the licensee did not comply with the section cited above in a flip action door lock was on the interior front door that can prevent anyone from leaving and entering the facility when used; facility does not have an approved delayed egress, 3 fire extinguishers were observed with tags that were last inspected by vendor on 4/18/2024, exterior gate latch observed with metal wire wrapped around the latch to prevent from opening and closing which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2026
Plan of Correction
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4
Licensee will remove flip action door lock from the front door and ensure no type of lock is used in the facility, obtain current tested fire extinguisher for the facility. Email pictures of items corrected to LPA by POC due date.
Type A
Section Cited
CCR
87468.1(a)(3)
Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such ... interfering with daily living functions such as eating, sleeping, or elimination.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA Delgado's observation, interview and record review, the licensee did not comply with the section cited above in Resident #3 room was observed with two beds and it was revealed that staff are sleeping in the same room with Resident which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2026
Plan of Correction
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2
3
4
Licensee will ensure that no Resident's personal rights are violated by staff and conduct in-service training with all staff and email a copy of training record to LPA by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Anthony Perez
NAME OF LICENSING PROGRAM MANAGER:
Yolanda Delgado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2026


LIC809 (FAS) - (06/04)
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