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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006566
Report Date: 01/15/2025
Date Signed: 01/15/2025 11:34:02 AM

Document Has Been Signed on 01/15/2025 11:34 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:HILLS OF SIERRA CHULA, THEFACILITY NUMBER:
306006566
ADMINISTRATOR/
DIRECTOR:		LADIA, BHONALYNFACILITY TYPE:
740
ADDRESS:19462 SIERRA CHULATELEPHONE:
(949) 316-2123
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY: 6CENSUS: 6DATE:
01/15/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee Maricel NepomucenoTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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
Licensing Program Analyst (LPA) Brandon Lopez and Licensing Program Manager (LPM) Sheila Santos made an announced visit to the facility for the purpose of conducting a Pre-licensing Inspection. LPA and LPM met with Applicants Team Brian Mahinay, Bhonalyn Ladia, Rosendo Carlo Mirando, Justin Duclayan, Christopher Cerame, and Johanna Gomez. The current Administrator for the facility is Rosendo Carlo Mirando. The facility will notify Community Care Licensing once Bhonalyn Ladia receives her Administrator certificate. LPA observed that Administrator Rosendo Carlo Mirando has a valid Administrator certificate which expires on April 8, 2026. All individuals present during the visit are background cleared and associated.

An initial application to operate a Residential Care Facility for the Elderly (RCFE) for a capacity of six non-ambulatory residents was received by Community Care Licensing (CCL) on December 11, 2024.This is a change of ownership with six residents already in care. The facility received an approved Fire Clearance by Orange County Fire Authority Inspector Shannon Chan on June 12, 2024.

The facility is a one-story home with five resident bedrooms, one staff room, two shared resident bathrooms, a kitchen, a dining room, a living room, a courtyard, and an attached two car garage. LPA and LPM accompanied by the Applicants Team, conducted a tour of the physical plant. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall in the entryway of the facility. LPA inspected the five resident bedrooms. The five resident bedrooms are clean and free of hazards. LPA observed all the resident bedrooms has the required furnishings of a bed, a chair, and chest of drawers, and a lamp. Resident beds have clean linens and blankets. LPA observed additional linens stored in a hallway closet. Resident bathrooms are clean. Bathrooms were equipped with grab bars and non-slip mats. Faucets and toilets were operational. Hot water temperature measured between 107.2 and 113.5 degrees Fahrenheit. LPA observed the facility has an emergency food and water supply and personal protective equipment stored in a hallway closet. CONTINUED ON LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 SIERRA CHULA, THE
FACILITY NUMBER: 306006566
VISIT DATE: 01/15/2025
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
26
27
28
29
30
31
32
LPA observed the facility has reading books and puzzles for resident use stored in the dining room. The facility has an internet device for resident use in the dining room. Resident and staff records are kept locked in a storage dresser in the dining room.

LPA observed the kitchen has a minimum two-day perishable and seven-day non-perishable food supply on hand. LPA observed the the electric stove, the refrigerator, the microwave, and the dishwasher to be clean and operational. LPA observed knives to be locked inside a kitchen cabinet. Fire extinguishers are located in the resident hallway and the garage. Fire extinguishers were observed to be charged and serviced as of April 11, 2024. LPA tested the wired smoke/carbon monoxide detectors which tested operational. Auditory devices tested operational for all exits. The centrally stored medication is located inside a kitchen cabinet. LPA observed the First Aid Kit had all the required components. The door leading to the attached two car garage is inaccessible to residents and is used for storage and for laundry. Cleaning supplies are located in the garage and will continue to be stored here.

LPA and LPM accompanied by the Applicants Team toured the outside of the facility and observed it to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the exterior of the facility is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises.

Component III was completed with the Applicants Team which provided information about how to operate the facility within compliance and reporting requirements. The Applicant Team were notified that the final application approval will be issued by the Centralized Applications Bureau (CAB) in Sacramento. An exit interview was conducted, and a copy of this report was provided to the Applicants Team.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2