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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530236
Report Date: 10/02/2024
Date Signed: 10/02/2024 03:36:15 PM

Document Has Been Signed on 10/02/2024 03:36 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HILLS OF STILLMAN, THEFACILITY NUMBER:
365530236
ADMINISTRATOR/
DIRECTOR:
CHAVEZ, REGINAFACILITY TYPE:
740
ADDRESS:940 STILLMAN AVENUETELEPHONE:
(714) 363-3752
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 18CENSUS: 14DATE:
10/02/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Administrator Regina ChavezTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Sarina Ramirez conducted an announced visit to the facility for the purpose of a Change of Ownership evaluation. LPA met with Administrator Regina Chavez. An initial application for change of ownership to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Centralized Applications Bureau (CAB) on 04/02/2024 for a total capacity of eighteen (18) bedridden residents. Fire clearance was granted on 08/05/2024. LPA observed the following:

There are nine (9) bedrooms and four (4) bathrooms. There are no bodies of water. The physical plant, in general, was in good repair. Buildings and grounds are free from hazards. Indoor and outdoor passageways were free of obstruction. There is a charged fire extinguisher, operating smoke alarms, and carbon monoxide detectors. There is a locked area for medications, cleaning supplies, and sharps. LPA observed a working telephone and basic laundry equipment. Resident bedrooms had the required bedding and furniture. Bedrooms had sufficient lighting. LPA measured the hot water temperature in the resident bathrooms, and it ranged from 104 to 108 degrees F. The facility had a sufficient amount of linen and hygiene items for the residents. The facility had a sufficient amount of nonperishable and perishable food items. The food was kept in a safe and healthful manner. The facility menu was available for review. The freezer was 0 degrees F. The refrigerator was 40 degrees F. Dishes, glasses, and utensils were in good condition. The facility had a designated area for staff and resident records. Emergency disaster plans, personal rights, and complaint posters were posted in a common area. The facility was equipped with a complete first aid kit and manual. There is adequate seating in the common areas. Facility had a supply of activities for the residents. Night lights were maintained in the hallways.

Pre-licensing inspection is complete, and no corrections are needed to be made. Facility appears to be ready for licensure. An exit interview was conducted where this report was discussed and provided to the applicant Regina Chavez.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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