Angel Gabriel

Allegation investigated: Staff has inappropriate interaction with resident in care.

On 09/03/2026 at 10:40AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA discussed the purpose of the visit with the Administrator, Delfina Rebollar. The investigation consisted of interviews and record review. In regards to the allegation of staff has inappropriate interaction with resident in care: LPA interviewed two (2) staff and three (3) residents. Two (2) out of three (3) residents denied the allegation and stated that they get along well with staff and are treated well. Staff denied the allegation and stated that reidents have not shared any concerns regarding staff interactions. Staff 2 (S2) is currently on leave from the home. Based on interviews and lack of further information, this allegation is UNSUBSTANTIATED. Unsubstantiated UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where this report LIC9099 and LIC9099C was discussed and a copy was provided to the Administrator, Delfina Rebollar.the state’s words, verbatim · CDSS document, Sep 3, 2026 · control 56-AS-20260309141237

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Becky Mann conducted an unannounced required 1-year visit to the facility. LPA met with Delfina Rebollar, Administrator and discussed the purpose of the visit. The facility is Residential Care Facility for the Elderly (RCFE). Licensed capacity of 6 with a current census of 4. LPA conducted an overall inspection of the facility, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with the required furniture such as beds, mattresses, night stands, storage space, and sufficient lighting. Bathrooms are clean and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The hot water temperature tested between 105 and 108 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. All the sharps are locked. There was a designated area for resident/staff files. Overall, the facility is clean, in good repair, and operating in a safe condition for residents in care. Administrator was unable to provide proof of Liability Insurance, deficiency issued. Food Service: Non-perishable and perishable food supply is sufficient for the number of residents. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed two (2) resident files for admission agreements, updated physician reports, and needs and services plans. Resident files are maintained and up to date. LPA reviewed two (2) residents medications. Medications are labeled and administered as prescribed. Medications are kept locked and inaccessible to residents in care. LPA also reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Facility staff records are up to date. Based on the observations made during today’s visit, one (1) deficiency were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C and LIC809D was discussed and provided to Administrator Delfina Rebollar.the state’s words, verbatim · CDSS document, Jan 23, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Becky Mann conducted an announced visit to the facility for purpose of Prelicensing evaluation. LPA met with Administrator/Applicant Delfina Rebollar. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 10/15/2024 for a total capacity of six (6) ambulatory. LPA observed the following: Structure: Facility is one story with six (6) bedrooms, one (1) staff room, seven (7) bathrooms, living room, dining area and kitchen. There's an attached four (4) car garage in the left side of the house. Heating/Cooling System: Central heating and air conditioning system installed with one (1) central panel. Bedrooms: Each resident bedrooms can accommodate any ambulatory resident. All resident bedrooms were furnished with beds, mattresses, chairs, closets, linens, adequate lighting and an operable smoke/carbon monoxide detectors. Bathrooms: The seven (7) resident/staff bathrooms have a working toilet, wash basin, and shower. LPA verified hot water temperature was measured between 108 and 114 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives, sharps, detergent and chemicals are stored in locked cabinets. There is a pantry stocked with non-perishable food and perishable food found in the refrigerator. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. Laundry room has a functional washer and dryer. Living/Family room: There's a living/family room with adequate seating for all residents and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in the staff room. Yards/Outside: Patio furniture for outdoor seating observed. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch, CCL complaint poster, house rules, personal rights and Emergency and Disaster Plan were observed in a common area. General items: Two (2) fire extinguishers were charged. The smoke and carbon monoxide detectors were tested and are operable. Resident records and staff records will be stored in a locked closet. First Aid kit with required components and locked area for medication storage was observed. LPA observed a facility phone and was operational as evidenced by LPA dialing the number. The phone number designated for the facility is 760-269-6614. There is enough Emergency water supply and the required 72-hour emergency food supply for residents and staffs available at the facility. Component III was completed on this day as well. 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 residents in care. Facility appears to be ready for licensure. An exit interview was conducted, and a copy of this report, LIC809, and LIC809C was discussed and provided to Applicant/Administrator Delfina Rebollar.the state’s words, verbatim · CDSS document, Jan 23, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity:6 Census (NA) COMP II Participants: Rebollar, Delfina owner/admin Interview Method: Telephone On 1/9/2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jan 9, 2025