The Innkeeper

Type of visit: Required - 1 Year

On 9/10/2026 at 1:20 PM, Licensing Program Analyst (LPA) Matthew Aguilar made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Administrator Israel Cabreros and was granted entry to the facility. At the time of the visit there were three (3) staff present, and five (5) residents present. The facility is a two (2) story house with four (4) resident bedrooms, three (3) bedrooms, four (4) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for six (6) non ambulatory residents, of which one (1) may be bedridden in bedroom one (1). The facility has six (6) hospice care waivers and the current census is five (5) residents. The facility is also licensed to care for residents with dementia. LPA was accompanied by a staff to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 80 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with the required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperatures in the bathroom to be at 114 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, and the disaster plan were posted in a common area. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine closet with the resident’s medications locked. LPAs observed first aid kit and first aid book at the facility. Yards/Outside: One shaded patio, one (1) side gate with self-latching handle on the right side of the house that leads into the backyard, attached two (2) car garage observed. All outdoor pathways were free of obstructions. Food Service: Seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. LPA observed that the facility has sufficient 72 hour emergency food and water. Care & Supervision: The facility has an Administrator present in the facility with enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. The facility is licensed for 1 bedbound resident. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed resident files reviewed were complete. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed staff files are complete. LPA observed that the facility completed quarterly fire and earthquake drills. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809 was discussed and provided to Administrator Israel Cabreros.the state’s words, verbatim · CDSS document, Sep 10, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Beena Singh conducted an announced visit to the facility for purpose of Pre licensing evaluation. LPA Singh met with Facility Administrator Israel Cabrerros. A change of ownership (CHOW) application to operate Residential Care Facility for Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 03/22/2025, for a total capacity of six (6), five Non-Ambulatory and one (1) Bedridden. Fire clearance was granted on 04/25/2025. LPA Singh observed the following: Structure: Facility is a two (2) story house downstairs with four (4) residents bedrooms ,three bedrooms -one(1) bathroom upstairs for staff and two (2) and 1/2 bathrooms downstairs, living room, dining area and kitchen. There was an attached two (2) car garage on the right side of the house. Heating/Cooling System: Central heating and air conditioning system installed with one (1) central panel located in the hallway to control entire house. Bedrooms: Each client bedrooms accommodate any non-ambulatory residents. All residents bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, a lamp and an operable smoke/carbon monoxide alarm. Bathrooms: The two (2) and 1/2 resident bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. LPA Singh tested the water temperatures in the clients' bathrooms. LPA Singh verified water temperature was measured at 119 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA Singh observed the stove to be operational. Refrigerator/freezer were in working condition. There is sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was in the laundry room and laundry detergents and cleaning supplies were observed in the laundry in a locked cabinet. Garage door is locked away from residents. Living/Family room: There was a living/family room with adequate seating for all clients and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the hallway of the residence. Yards/Outside: Patio furniture for outdoor seating observed. Self-latching handle gate on left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch was observed posted near the main entrance. There was Let-Us-No poster and Labor Laws observed. General items: One (1) fire extinguisher was charged and located in the pantry. Three (3) combined smoke detectors and carbon monoxide detectors were tested and were observed to be in working order. Client records and staff records will be stored in a locked cabinet in the hallway. First Aid kit with required components, and locked area for medication storage was observed. LPA Singh observed a facility phone and the phone number designated for the facility is 951-256-1356. Liability insurance dates valid through 07/01/2025-07-01-2026. There is enough Emergency water supply and the required 72 hour emergency food supply for clients and staffs available at the facility. Component III was completed on this day as well. Additionally, LPA Singh observed facility having Visitor Sign In/Sign Out Sheet and Client Sign In/Sign Out Sheet, upon entering facility. 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 clients in care. Facility appears to be ready for licensure. An exit interview was conducted, and a copy of this report, LIC 809 was discussed and provided to Applicant/Administrator Facility Administrator Israel Cabrerros.the state’s words, verbatim · CDSS document, Oct 2, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Charity Cabreros CEO/ Israel Cabreros Administrator Interview Method: Teams meeting On July 29,, 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 the 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, Jul 29, 2025