Casa Del Cielo

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Amy Domingo conducted a Case Management visit regarding Room #2 bedridden application. LPA identified herself and discussed the purpose of the visit with Administrator Virgilia Rebosura Licensee applied for Room #2 to become a room for a bedridden resident. There is an approved Fire Clearance for the change in Room #2 to be for a bedridden resident. Approved Fire Safety Inspection Request dated 04/30/2026 . As of today, there are six (6) clients in care. LPA toured the facility and a had a discussion with the licensee regarding operation. LPA toured the physical plant. Client bathrooms are equipped with cleaning products and paper towels; toxic substances are stored in a locked cabinet. Medication storage and administration logs are located in the medication room. Sufficient space to conduct activities was present; facility posting requirements were present in a common area. No deficiencies were issued during this visit. An exit interview was conducted with Virgilia Rebosura to whom a copy of this report, along with Licensee/Appeal Rights (LIC 9058 03/22), were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jun 9, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Dang Nguyen and Eryn Kane made an unannounced visit to conduct a Required Annual Inspection. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee/Administrator Virgilia “Gigie” Rebosura. According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. Per LPA observation, LIC602 Physician’s Reports, and staff interviews: During today’s inspection, there were a total of six (6) residents in care, of whom one (1) was ambulatory, four (4) were non-ambulatory, and one (1) was bedridden [Resident #1 (R1)]. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] The presence of this bedridden resident represents a violation of the conditions/limitations of the facility license and fire clearance. The facility’s license did not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present. LPAs reviewed care records for all current residents and personnel files for all active staff. LPAs, accompanied by Licensee/Administrator, also toured the interior and exterior of the facility, and inspected all common areas, restrooms, and resident bedrooms. The facility did not have a working carbon monoxide alarm, as required. In the facility’s dining room area were two (2) disinfecting chemical sprays and one (1) container of disinfecting chemical wipes, unsecured/unlocked. [CONTINUED ON LIC 809-C, 1 of 2] [CONTINUED FROM LIC 809] In the facility’s backyard was one (1) container of disinfecting chemical wipes, one (1) pitchfork with metal points, one (1) full length shovel with metal blade, and one (1) full-length metal pry bar tool, unsecured/unlocked. According to LIC602 Physician’s Reports, five (5) of the six (6) residents in care [R1 through Resident #5 (R5)] had Dementia, and their respective physician had determined that the resident should not have direct access to the above items. Beyond the above, the facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 74 F. Hot water temperature at taps used by residents for grooming were compliant in temperature: Bathroom #1 Sink was 109.2 F and Bathroom #2 Sink was 109.4 F. Refrigerators and freezers to preserve perishable food were also all compliant in temperature. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. Medications were labeled, as required, and stored in locked areas. There were no fireplaces of open-faced heaters accessible to residents. Confidential records were stored in locked areas. No pools or similar bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Smoke alarms, night lights, emergency lighting, and facility telephone were all working. The facility’s fire extinguishers were serviced within the last twelve (12) months. Required licensing postings were observed in visible areas of the facility. There were reserve toiletry supplies, spare linens, and Personal Protective Equipment (PPE) present. Licensee presented proof of current business liability insurance. During review of resident records, LPAs observed, and manager interview confirmed: For four (4) of six (6) residents (R3 through R6), Licensee did not have the name, address, and telephone number of the residents’ dentist to be called in the event of an emergency, as required. R1 and R2 had supplemental oxygen, R2 had a urinary catheter, and R4 had Diabetes (all of which are “Restricted Health Conditions” in the RCFE setting, per regulation). However, Licensee did not have written proof that four (4) of four (4) direct care staff [Staff #1 (S1) through Staff #4 (S4)] had yet received hands-on training from a licensed professional on administration of oxygen, catheter care, and diabetes, which was required before care for these conditions began. [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 809-C, 1 of 2] R1, R2, and R3 were each receiving hospice care services. However, Licensee did not have written proof that four (4) of four (4) direct care staff (S1 through S4) received “training specific to the current and ongoing needs of the individual resident receiving hospice care” from the resident’s hospice agency personnel (such as the assigned nurse case manager) prior to the start of the hospice care, as was required. Licensee also did not have proof/documentation that they held a care meeting/conference with the responsible person and other appropriate parties for six (6) of six (6) residents (R1 through R6), for the purpose of reviewing and updating the resident’s written record of care / care plan, within the last twelve (12) months, as was required. During review of staff records, LPAs observed, and manager interview confirmed: Licensee did not have proof of current First Aid Training for one (1) of four (4) direct care staff (S2). Licensee did not have written proof that three (3) of four (4) direct care staff (S2, S3, and S4) had completed at least twenty (20) hours of ongoing training within the last year, to include at least eight hours on dementia care and at least four hours on postural supports, restricted health conditions, and hospice care, as required. Licensee did not have written proof that four (4) of four (4) staff who assist residents with medication administration had received at least eight (8) hours of ongoing medication in-service training within the last twelve (12) months, as required. Eight (8) deficiencies were cited per California Code of Regulations, Title 22, and two (2) deficiencies were cited per California Health and Safety Code (refer to the LIC809-D pages). Since one of these deficiencies represents a violation of the facility’s prior-approved fire clearance, an immediate civil penalty of $500 was charged/assessed (refer to the LIC421-IM page). Plans of Correction were jointly developed with the Licensee. LPAs also provided Technical Assistance (TA) regarding knob protectors for safeguarding the facility’s kitchen range and periodic measuring of residents’ body weights (refer to the LIC9102-TA pages). An exit interview was conducted with Licensee/Administrator Virgilia “Gigie” Rebosura, to whom a copy of this report, the LIC 809-D pages, the LIC421-IM page, the LIC9102-TA pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.the state’s words, verbatim · CDSS document, Apr 17, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Sherwin Sanchez. Administrator Virgilia Rebosura arrived shortly after LPA. The facility's license shows a maximum capacity of six (6) residents, all of whom may be non-ambulatory. Additionally, the facility is approved for two (2) hospice waivers. During today’s inspection there were six (6) residents in care. LPA and Administrator Rebosura toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Bathroom sink was 106F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Kitchen area was clean and organized. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Rebosura, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher was serviced within the last 12 months. First aid kits were complete and readily accessible. Last emergency drill conducted was 3/5/25, for the topic of earthquakes. Required licensing postings were observed in visible areas of the facility. LPA interviewed zero (0) staff and one (1) client, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator Rebosura to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Rodgers was granted entry into the facility by Care Giver Sherwin Sanchez, after identifying herself and stating the purpose of the inspection. Later Licensee Virgilia Rebosura joined the visit. LPA was accompanied Licensee Virgilia Rebosura during a tour of the facility. Tour was conducted inside and out and included a sample of resident bedrooms as well common areas. No bodies of water are on premises. Passageways were free from obstructions. According to Licensee Rebosura there are no weapons and/or ammunition stored on the premises. No delayed Egress or secured perimeter doors were present. Resident's room temperatures were within a comfortable range. Each resident had clean and sufficient bed linens. All extra linens, towels, and washcloth were present All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Hot water temperature in residents’ bathrooms were compliant. [CONTINUED ON LIC 809-C] CONTINUED FROM LIC 809] Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Food was observed to be properly stored and labeled. Chemicals and cleaning supplies were stored in a locked closet and outside storage area. The medication is secured and is in a locked medication cabinet and medications were labeled and kept in compliance with label instructions. Staff records review verified that all staff records were complete and compliant. Staff records review verified that all staff have a current First Aid certificate and CPR certificates Resident records were reviewed and confirmed compliant. Administrator’s certification is current. LPA reviewed the theft and loss policy and procedures. LPA interviews with Director Rebosua confirm residences are provided with assistance necessary for medical and dental appointments. LPA reviewed the theft and loss policy and procedures. No deficiencies were cited at the time of visit. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. An exit interview was conducted, this report was discussed with Licensee Virgilia Rebosura , a copy along with Licensee/Appeal Rights (LIC 9058 01/2106), and their signature on this form acknowledges receipt and a copy of the report was given to the Licensee Virgilia Rebosura..the state’s words, verbatim · CDSS document, Mar 29, 2024