331881464-1-9-2025-18-AS-AZEO-DCS2C6-20250109161614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881464
Report Date: 01/09/2025
Date Signed: 01/09/2025 04:16:24 PM

Document Has Been Signed on 01/09/2025 04:16 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	HILLS OF SOUTH CREEK I, THE		FACILITY NUMBER:	331881464
ADMINISTRATOR/ DIRECTOR:	RAMIREZ, SOPHIA		FACILITY TYPE:	740
ADDRESS:	39869 SOUTH CREEK CIRCLE		TELEPHONE:	(714) 430-7672
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY: 6		CENSUS: 4	DATE:	01/09/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:20 PM
MET WITH:	Heddy Mae Oyson		TIME VISIT/ INSPECTION COMPLETED:	04:25 PM

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Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by Administrator Heddy Mae Oyson, notified her of the purpose for the visit and was allowed to enter the facility to conduct the inspection.

Facility Overview: The facility is a single story building with (4) residents bedrooms, one(1) staff bedroom, three(3) bathrooms, a living room and a kitchen area. There is no gated pool and there are no firearms on the premises.

Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements.

Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen area, inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPA observed fire extinguishers to be in compliance with the department requirements and with an expiration date of May 22, 2025. The water temperature was measured at 106.8 F, meeting the department's requirement

Continued 809-C......

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: HILLS OF SOUTH CREEK I, THE	FACILITY NUMBER: 331881464
	VISIT DATE: 01/09/2025

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Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of June 10, 2026 and a CPR certification with the expiration date of September 18, 2026

Record Review and Resident/Staff Files: LPA reviewed files for four(4) staff members, confirming criminal clearances, and CPR/First Aid certification. Four (4) residents' files were reviewed and contained all required documentation. LPA observed first aid kit to be locked and stored in the hallway pantry. The residents files were kept in a locked cabinet next to the dining room area and the staff files were kept in a locked pantry in the hallway.

Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in the hallway in a pantry. LPA reviewed medications for four residents, confirming that all medications were listed and accounted for.

Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 1-3-2025, which met department requirements. All facility exits were clear of obstructions.

No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to administrator Heddy Mae Oyson.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC809 (FAS) - (06/04)

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