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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880925
Report Date: 08/06/2021
Date Signed: 09/29/2021 09:58:17 AM

Document Has Been Signed on 09/29/2021 09:58 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:WHISPERING HILLS PLACEFACILITY NUMBER:
331880925
ADMINISTRATOR:DUCLAYAN, DAMON M.FACILITY TYPE:
735
ADDRESS:37273 WHISPERING HILLS DRIVETELEPHONE:
(951) 970-8323
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 4CENSUS: 0DATE:
08/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Damon Duclayan, LicenseeTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Deborah Mullen made a visit to the facility to conduct an annual inspection with an emphasis on infection control. The LPA, met by Licensee, Damon Duclayan. Currently there are no clients in placement, however the facility is approved for 4 residents.

During today's visit, the LPA inspection the facility and made observations pertaining to the facility's infection control measures. The LPA observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions and sufficient PPE supplies. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE supplies and overall infection control. The facility has not submitted a Mitigation Plan, but will submit it to the Department by October 8, 2021.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview was conducted and a copy of this report was reviewed with and provided to Mr. Duclayan.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Deborah Mullen
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2021
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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