336426840-5-26-2026-56-AS-JPRO-DUG23T-20260526170253

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336426840
Report Date: 05/26/2026
Date Signed: 05/26/2026 05:03:01 PM

Document Has Been Signed on 05/26/2026 05:03 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:	SEBASTIAN HOME		FACILITY NUMBER:	336426840
ADMINISTRATOR/ DIRECTOR:	ALLEN DE LEON		FACILITY TYPE:	735
ADDRESS:	7341 SEBASTIAN AVENUE		TELEPHONE:	(951) 934-3997
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY: 4		CENSUS: 4	DATE:	05/26/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:15 PM
MET WITH:	Allen De Leon, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:05 PM

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Licensing Program Analyst (LPA) Javier Prieto conducted an unannounced required 1 year visit to the facility. LPA met with Allen De Leon, Administrator and discussed the purpose of the visit.

The facility is an Adult Residential Facility (ARF), license capacity of (4) with a current census of (4). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

LPA inspected the facility inside and out. Indoor and outdoor passageways were kept free of obstruction. Facility living room, dining room, family room furniture is in good repair and sufficient for clients in care. The facility has sufficient lighting and is maintained at a comfortable temperature of 74 degrees F. Laundry equipment and telephone service is in working condition. Facility has no bodies of water. The back yard is gated with a covered patio and outdoor furniture in good repair. Facility has no firearms.

Facility plans for client community activities and programs. Facility has board games, art supplies and videos for indoor client activities. Facility has sufficient space for outdoor client activities. LPA inspected the kitchen. Facility has sufficient non-perishable and perishable food for the number of clients in care. Facility food is stored in a safe and

NAME OF LICENSING PROGRAM MANAGER: Karen Clemons
NAME OF LICENSING PROGRAM ANALYST: Javier Prieto
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026

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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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)

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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: SEBASTIAN HOME	FACILITY NUMBER: 336426840
	VISIT DATE: 05/26/2026

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Facility has sufficient cups, plates and utensils for client use. Kitchen hot water temperature tested within regulation at 107.5 degrees F. Sharps, disinfectants, and chemicals are kept locked and inaccessible to clients in care.

LPA inspected client bedrooms. Bedrooms are equipped with clean mattresses, night stands, and sufficient storage space. Bedrooms have sufficient linen and lighting. LPA inspected client bathrooms. Bathrooms were operating in a safe and sanitary condition.

The facility is equipped with operating smoke and carbon monoxide alarms and fully charged fire extinguisher. A Disaster Drill was conducted on 03/15/2026. Facility has posted in a common area the facility sketch, personal rights, disaster plan and emergency numbers. Extra linen, towels, personal hygiene products were stored in the hallway cabinet. Facility has a complete first aid kit and emergency supplies.

Client medications are kept safe and locked and inaccessible to clients in care. Client medication is labeled and administered as prescribed by client physician.

LPA reviewed (4) client files for admission agreements, personal rights statement, Individual Program Plan (IPPs) and updated physician reports, all had the required documentation. LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings, all had the required documentation.

Overall, the facility is clean, in good repair, and operating in safe conditions. No deficiencies were cited during today's visit.

An exit interview was conducted, where this report was discussed and a copy was provided to Allen De Leon at the conclusion of the visit.

NAME OF LICENSING PROGRAM MANAGER: Karen Clemons
NAME OF LICENSING PROGRAM ANALYST: Javier Prieto
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026

LIC809 (FAS) - (06/04)

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