306002918-10-22-2026-22-AS-RMAZ-DZ4Q99-20261022115758

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306002918
Report Date: 10/22/2026
Date Signed: 10/22/2026 11:58:38 AM

Document Has Been Signed on 10/22/2026 11:58 AM - 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:	SUNNY HILLS HOMES		FACILITY NUMBER:	306002918
ADMINISTRATOR/ DIRECTOR:	MARIA/NESTOR MOYA		FACILITY TYPE:	740
ADDRESS:	25402 COSTEAU DRIVE		TELEPHONE:	(949) 370-6639
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY: 5		CENSUS:	DATE:	10/22/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:25 AM
MET WITH:	Maria Moya Nestor Moya		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility for the purpose of completing the required annual inspection. Upon arrival, LPA was greeted by facility staff and granted entry. LPA met with Maria Moya, Administrator, and explained the nature and purpose of the visit. There are currently three (3) residents residing at the facility, one (1) of whom is receiving hospice services.

The facility is a two-story building located in a residential neighborhood. The facility consists of three (3) resident bedrooms on the first floor, three (3) bedrooms on the second floor, three (3) bathrooms (two on the first floor and one on the second floor), a living rooms, dining rooms/kitchen, and an attached two-car garage. The second floor is occupied by the licensee and is inaccessible to residents in care. LPA conducted a tour of the interior and exterior of the facility. Department required postings were observed throughout the facility. The facility was operating within its approved capacity limitations. LPA inspected the kitchen and food storage areas and observed a minimum of one (1) week of nonperishable food and two (2) days of perishable food supplies. Emergency food, water, and other emergency supplies were observed stored in the garage. Additional food supplies were maintained in a freezers, one (1) spare refrigerator, located in the garage. The facility was maintained at a comfortable temperature. LPA inspected the centrally stored medications, which were maintained in a secured and locked cabinet located in the kitchen. Medications were reviewed and observed to be appropriately labeled and stored in a manner inaccessible to residents in care. LPA also observed a first aid kit stored with the medications. LPA inspected the facility bathrooms and measured the hot water temperature at 116.9 degrees Fahrenheit. All bathrooms were observed to have adequate supplies of

CONTINUED ON LIC809-C

Kevin Saborit-Guasch
Ruth Martinez
	DATE: 10/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2026

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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNNY HILLS HOMES	FACILITY NUMBER: 306002918
	VISIT DATE: 10/22/2026

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soap, toilet paper, and towels. Bathrooms were equipped with required safety features, including nonskid mats and grab bars. Lighting throughout the facility was sufficient to ensure the safety and comfort of residents in care. The facility maintained an adequate supply of hand hygiene products, cleaning supplies, and disinfectants. LPA observed toxic chemicals, cleaning solutions, and disinfectants stored underneath kitchen sink and in the garage. The laundry area, equipped with a washer and dryer, was also located in the garage. LPA observed that the facility maintained a clean and adequate supply of linens. Resident bedrooms were inspected and observed to have sufficient lighting to ensure the safety and comfort of residents. All resident bedrooms inspected contained the required furnishings and provided adequate storage space for residents' personal belongings. LPA tested the smoke detectors and carbon monoxide detectors and found them to be operational. LPA toured the exterior of the facility and observed that outdoor passageways were free of obstructions. The backyard included a covered seating area available for residents' use and enjoyment. LPA also inspected the second floor of the facility, which is occupied exclusively by the licensee. No residents in care reside on the second floor. LPA verified that residents in care do not have access to the second floor of the facility. LPA observed a fire extinguisher located in the kitchen. The fire extinguisher was charged, properly mounted, and had a service date of October 14, 2026. The facility conducts fire drills every three (3) months. LPA reviewed the facility's fire drill logs and verified that the most recent fire drill was conducted on July 7, 2026.LPA proceeded with a review of facility records. LPA reviewed two (2) resident records and observed that all required documentation was present and maintained in the residents' files. LPA also reviewed two (2) employee records. All employees present had current criminal record clearances and were properly associated with the facility. The employee records reviewed contain current First Aid certifications.

Based on observations made and records reviewed during today's visit, no deficiencies were noted in the areas inspected pursuant to Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted with Administrator, during which the inspection findings were discussed. A copy of this report was provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: Ruth Martinez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2026

LIC809 (FAS) - (06/04)

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