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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201737
Report Date: 03/04/2025
Date Signed: 03/04/2025 03:24:49 PM

Document Has Been Signed on 03/04/2025 03:24 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:HILLSIDE RANCH CORPORATIONFACILITY NUMBER:
435201737
ADMINISTRATOR/
DIRECTOR:		APOSTOL, OBEDFACILITY TYPE:
735
ADDRESS:2320 SHAFER AVENUETELEPHONE:
(408) 930-9872
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 6CENSUS: 5DATE:
03/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Obed ApostolTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's annual inspection. LPA met with Licensee, Obed Apostol.

During visit, LPA toured the facility to include the garage, staff bedrooms, kitchen, resident bedrooms, bathrooms, living room, and backyard. All fire exits routes and passageways are free and clear of obstruction. Pool observed double fenced. All staff members present are fingerprint cleared and associated to the facility.

Facility has a central entry point for sign-in. No clients observed on site during initial inspection. Facility's temperature maintained at 63 degrees F. During visit, the heater was turned on and the temperature was set to 74 degrees F. Licensee was advised to ensure the facility temperature is at least 68 degrees F. Fire extinguisher last serviced on 04/12/2024. Facility has two operable carbon monoxide detectors. Facility has two refrigerator/freezers in the kitchen which stores food supplies. Refrigerator #1's temperature to the left of the kitchen maintained at 40 degrees F. Freezer #1 temperature maintained at 0 degrees F. Refrigerator #2 temperature to the right of the kitchen maintained at 44 degrees F. Freezer #2 temperature maintained at below 0 degrees F. Facility has 7 days worth of non-perishables and 2 days worth of perishable foods. Chemicals, disinfectants, medications and sharp objects observed locked and all stored separately. Bathroom hot water temperature maintained at 108 degrees F.

Resident bedrooms observed well maintained and furnished with beddings, linens, dressers, night stands, and adequate lighting / lamps.

See LIC809-C.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: HILLSIDE RANCH CORPORATION
FACILITY NUMBER: 435201737
VISIT DATE: 03/04/2025
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LPA reviewed 3 resident files to include their admission agreement, physician's report, updated appraisal needs and services plan, consent forms, weight record, safeguard personal property form, safeguard of cash resources, and centrally stored medication records. 2 out of 3 resident's had P&I money. P&I money was counted with the Licensee and all money was accounted for with no issues noted. 3 out of 3 residents centrally stored medications and record was review with no issues noted.

LPA reviewed 2 staff files to include the LIC501, LIC503, First Aid Certification, IDs and training records. Staff are provided annual training.

Facility has an emergency disaster plan. Drills are being conducted quarterly and the last drill was completed in December 2024 and January 2025. LPA observed the facility has emergency disaster supplies to include a luggage full of non-perishable foods, personal grab-and-go backpacks, flashlights and batteries.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Licensee, Obed Apostol and a copy of the report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
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