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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880925
Report Date: 06/23/2023
Date Signed: 06/23/2023 02:16:42 PM

Document Has Been Signed on 06/23/2023 02:16 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
RIVERSIDE AC/SC, 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: 4DATE:
06/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee Genevie SengdalaTIME COMPLETED:
02:15 PM
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On 6/23/2023, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced annual required visit to the facility at 1:00 p.m. LPA was greeted and granted entry by Licensee Genevie Sengdala who was informed of the purpose of the visit. There are currently four (4) clients residing at the home, but during the visit clients were at day program.

The facility is made up of a two-story home with four (4) client bedrooms, two (2) client bathrooms, family room, dining area, kitchen, and an attached garage. LPA conducted a tour of the interior and exterior, and reviewed facility documents. LPA observed the following:

Bedrooms: Client bedrooms were each furnished with a bed, chair, closet, clothing storage and lighting.

Bathrooms: Both bathrooms have a working toilet, wash basin, and were equipped with a grab bar in the shower. The facility has clean towels, blankets, and linen, available in different colors for each client.

Kitchen: LPA observed a sufficient supply of dishes, glasses, utensils, pots, and pans. The stove is operational. Refrigerator and freezer were in working condition. LPA observed 7-day non-perishable food supply and emergency food available for the clients. Knives are secured in a locked kitchen cabinet.
Laundry: Laundry area had a washer and dryer.

Continued on LIC809-C...
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2023
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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Document Has Been Signed on 06/23/2023 02:16 PM - It Cannot Be Edited


Created By: Janette Romero On 06/23/2023 at 01:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WHISPERING HILLS PLACE
FACILITY NUMBER: 331880925

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85076(d)(1)
Food Service
(1) Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in which the perishable food supply does not meet the Department's 2-day requirement for four (4) clients, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/26/2023
Plan of Correction
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Licensee stated they will go grocery shopping today and agred to maintain a 2-day supply of perishable food moving forward. Proof of correction for today's visit to be submitted to CCLD by close of business on 6/26/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Esquivel
LICENSING EVALUATOR NAME:Janette Romero
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023


LIC809 (FAS) - (06/04)
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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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WHISPERING HILLS PLACE
FACILITY NUMBER: 331880925
VISIT DATE: 06/23/2023
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Centrally Stored Medications: LPA observed a first aid kit with required components. Client medications are secured in a locked cabinet near the living room.

Living/Family room: The family room had a working television. Let-Us-No poster, Personal Rights information, emergency phone numbers, and facility sketch were posted throughout the home.



Yard/Outside Area: A wood wall secured the entire backyard. All outdoor pathways were free of obstructions. There were no firearms or ammunition observed at the facility, and LPA was informed the facility will not store firearms or ammunition on the premises.

LPA observed the 2-day supply of perishable food did not meet Departmental requirements for the amount of clients in care. As a result, LPA issued a Type B deficiency.

LPA attempted to conduct the facility’s annual earlier in the day (9:30 a.m., on 6/23/2023) but was unsuccessful due to no one being available to allow LPA in the home for the inspection during that time. Licensee Sengdala stated no one is in the home from approximately 8:00 a.m. to 3:30 p.m. on a weekday basis and weekend outings to the community take place from 11:00 a.m. to 3:00 p.m. Licensee Sengdala stated that someone can be available to allow Community Care Licensing (CCL) staff in the home after 12:00 p.m. on a daily basis. Licensee Sengdala provided the following phone number (951) 970-8323 to ensure that someone is available to allow CCL staff to enter the home.

An exit interview was conducted, and a copy of this report was reviewed and provided to Licensee Sengdala along with an LIC809-D and Appeals Rights.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
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