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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000012
Report Date: 05/31/2024
Date Signed: 05/31/2024 12:14:25 PM


Document Has Been Signed on 05/31/2024 12:14 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:HILLHURST MANORFACILITY NUMBER:
306000012
ADMINISTRATOR:SCHENKELBERG, PETER J.FACILITY TYPE:
740
ADDRESS:24052 HILLHURSTTELEPHONE:
(949) 357-6666
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 6DATE:
05/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Peter SchenkelbergTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Peter Schenkelberg and explained the reason for the visit. The Administrator's certificate expires on October 13, 2025. LPA and Administrator toured the facility. LPA observed the fireplace in the living room is screened. LPA observed the See Something, Say Something poster (PUB 475) posted in the living room by the front door. The facility is a two story house with 8 bedrooms and 7 bathrooms, a living room, dining room, kitchen and a 2 car garage. The second floor is off limits to residents and there is no way for residents to access the second floor. The garage is used for storage and kept locked. LPA observed medications are kept locked in the kitchen closet. Knives are kept locked in a kitchen cabinet. Cleaning supplies are kept locked under the kitchen sink. LPA observed a two day perishable and a seven day non-perishable food supply on hand in the kitchen. LPA observed the 4 burner stove lights unassisted. LPA observed the kitchen is clean and organized. The smoke detectors and carbon monoxide detector tested operational. LPA observed the fire extinguisher is fully charged. LPA and Administrator toured the resident rooms. LPA observed all resident rooms had the required furnishings. The hot water in all resident bathrooms measured between 104.5 degrees Fahrenheit to 107.0 degrees Fahrenheit. LPA observed all resident bathrooms are clean and operational. LPA and the Administrator toured the outside of the facility. LPA observed the exit gate is operational. There is a shaded seating area outside for residents. No obstacles or hazards observed outside of the facility. LPA reviewed 6 resident files and medications. No discrepancies observed. LPA reviewed 2 staff files. No discrepancies observed. All staff had the required training and CPR/First Aid certification. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted with the Administrator and a copy of the report provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2024
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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