<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006495
Report Date: 03/09/2026
Date Signed: 03/09/2026 02:00:29 PM

Document Has Been Signed on 03/09/2026 02:00 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:HILLS OF SANTA TERESA, THEFACILITY NUMBER:
306006495
ADMINISTRATOR/
DIRECTOR:		MIRANDA, ROSENDO CARLAFACILITY TYPE:
740
ADDRESS:17698 SANTA TERESA CIRCLETELEPHONE:
(714) 430-7672
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 6CENSUS: 3DATE:
03/09/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Rosendo Carla Miranda - AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On March 9, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit and requesting documentation. LPA introduced self to staff, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo Carla Miranda arrived a short time later to assist with the visit.

During today’s visit, LPA and AD conducted a tour of the physical plant and observed the following: There are currently three residents in care with three staff present. Residents were observed dressed and groomed with no concerns. Water, electricity, gas, and air conditioning are all operational. Bathroom faucets are verified to dispense hot water between 110.3 and 112 degrees F. Kitchen appliances are operational and the facility has a two day supply of perishable and seven day supply of nonperishable food items were available. LPA observed overgrown grass and weeds in the front yard and backyard, as well as a sliding door screen with two 1 inch holes in it. Interviews were conducted with residents and three staff. Staff interviewed reported that they were not paid on March 5, 2026 for days worked in February 2026 and were informed that the next pay disbursement date would be March 22, 2026 for all wages due. The facility does not currently have Liability Insurance. Two staff present and providing care were background cleared but not associated to the facility.

Based on today's observations, deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations and Health and Safety Code. CIVIL PENALTIES ASSESSED.

An exit interview was conducted with Administrator Rosendo Carla Miranda, and a copy of this report, LIC809-Ds, LIC421s, and appeal rights were provided at exit.
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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)
Page: 2 of 4
Document Has Been Signed on 03/09/2026 02:00 PM - It Cannot Be Edited


Created By: Eboni Bentley On 03/09/2026 at 12:28 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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HILLS OF SANTA TERESA, THE
FACILITY NUMBER: 306006495

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/09/2026
Section Cited
CCR
87355(e)(3)

1
2
3
4
5
6
7
87355 (e)(3) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (3)Request a transfer of a criminal record clearance...

This requirement is not met as evidenced by
1
2
3
4
5
6
7
The Administrator stated they will associate S1 & S2 to the facility and submit a written statement of acknowledgement and understanding to CCLD via email by POC due date.
8
9
10
11
12
13
14
Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPA reviewed S1’s & S2's record and found that they are not associated with the facility. This poses an immediate health, and safety, risk to persons in care. CIVIL PENALTY ASSESSED.
8
9
10
11
12
13
14
Type A
03/10/2026
Section Cited
CCR87303(a)

1
2
3
4
5
6
7
87303(a)The facility shall be clean, safe sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will submit a plan is to have both the front and backyards maintained and will provide proof of maintenance to CCLD by POC due date.
8
9
10
11
12
13
14
Based on observation, the facility failed to comply with the section cited above in two out of two yards and one screen, which poses an immediate risk to persons in care. LPA observed overgrown grass and weeds in the front and back yards, as well as a sliding door screen with two 1 inch holes.
8
9
10
11
12
13
14
A deficiency was previously cited on 3/3/2026 for failure to comply with CCR 87303(a)
CIVIL PENALTY ASSESSED.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Eboni Bentley
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2026


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 03/09/2026 02:00 PM - It Cannot Be Edited


Created By: Eboni Bentley On 03/09/2026 at 01:06 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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HILLS OF SANTA TERESA, THE
FACILITY NUMBER: 306006495

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/10/2026
Section Cited
CCR
87213

1
2
3
4
5
6
7
87213 The licensee shall have a financial plan that [...] assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required .. licensing agency. This requirement is not evidenced by:
1
2
3
4
5
6
7
Licensee will submit a financial plan to ensure that staff receive their pay timely for next pay period and ongoing. Administrator/Licensee will submit proof to CCLD via email or fax by POC date.
8
9
10
11
12
13
14
Based on observation, interviews, and record review, staff did not receive paychecks timely, which poses an immediate health and safety risk to persons in care. Staff stated they were due pay on 3/5/2026 and did not receive a paycheck as of 3/9/2026.
8
9
10
11
12
13
14
A deficiency was previously cited on 12/31/2025 for failure to comply with CCR 87213.
CIVIL PENALTY ASSESSED.
Type A
03/10/2026
Section Cited
HSC1569.605

1
2
3
4
5
6
7
On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests...This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Administrator/Licensee will submit proof of bonded liability insurance for the facility to CCLD via email or fax by POC date.
8
9
10
11
12
13
14
Based on observation and interviews, the licensee did not comply with the section cited above, which poses an immediate health, safety, and personal rights risk to persons in care. Administrator stated the facility does not have current liability insurance.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Eboni Bentley
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2026


LIC809 (FAS) - (06/04)
Page: 4 of 4