365530422-1-30-2026-56-AS-MECA-DQTPER-20260130101535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 365530422
Report Date: 01/30/2026
Date Signed: 01/30/2026 10:15:45 AM

Document Has Been Signed on 01/30/2026 10:15 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	OAK HILLS HOME CARE		FACILITY NUMBER:	365530422
ADMINISTRATOR/ DIRECTOR:	VILLANUEVA, JESSICA		FACILITY TYPE:	740
ADDRESS:	7518 EL MANOR ROAD		TELEPHONE:	(760) 706-8988
CITY:	OAK HILLS	STATE: CA	ZIP CODE:	92344
CAPACITY: 6		CENSUS: 0	DATE:	01/30/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:15 AM
MET WITH:	Jessica Villanueva- Licensee		TIME VISIT/ INSPECTION COMPLETED:	10:30 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) Michelle Echeverria arrived at Oak Hills Home Care to conduct an announced Pre-Licensing visit for licensure. LPA was greeted by Licensee, Jessica Villanueva. LPA introduced self and stated purpose of the visit. LIC200 application was submitted on 07/17/25 for (5) non-ambulatory residents and (1) bedridden resident. Fire Safety Inspection clearance was granted for (5) non-ambulatory residents and (1) bedridden resident on 09/03/25. LPA toured the facility inside and outside and observed the following: Structure: Facility is a one story house with (4) resident bedrooms, (3) bathrooms, living room, family room, dining room, dining area, kitchen, laundry room, attached garage, indoor patio, and backyard. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control entire house and (2) inaccessible fireplaces. Bedrooms: Bedrooms #1, #3 and #4 can accommodate up to (2) non-ambulatory residents in each room and bedroom #2 accommodates only (1) bedridden resident with a total of (6) residents in the facility. All bedrooms have the required bedding and furniture, such as, clean mattresses/linens, nightstands, dressers, chairs, and lighting. Bathrooms: The bathrooms have a working toilet with safety rail, wash basin, shower with safety rail and an adequate supply of toilet paper and soap. Water tested in the bathroom faucet measured at 120 degrees Fahrenheit.

NAME OF LICENSING PROGRAM MANAGER: Nedra Brown
NAME OF LICENSING PROGRAM ANALYST: Michelle Echeverria
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

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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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)

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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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OAK HILLS HOME CARE	FACILITY NUMBER: 365530422
	VISIT DATE: 01/30/2026

NARRATIVE

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Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives, sharps, detergent, and chemicals are stored in locked compartments. There was a pantry stocked with non-perishable food and perishable food found in the refrigerator. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. A functional washer and dryer are located inside the laundry room.

Living/Family room: There was a furnished family room with a tv and activities observed along with a furnished living room.

Linens and Hygiene Supplies: An adequate supply of linens and hygiene supplies stored in a closet.

Yards/Outside: LPA observed one indoor patio with bbq island, patio table, patio furniture, and an empty inaccessible hot tub. There was also a side gate with self-latching handle on the left and right side of the house that leads into the backyard, and (1) shed used for storage. All outdoor pathways were free of obstructions.

Emergency Phone Numbers, and Exit Plan: Facility sketch, CCL complaint poster, emergency disaster plan, infection control plan, personal rights, administrator's certificate, house rules, visiting policy, theft policy and an empty frame for the facility's license were observed posted by the entrance of the home.

General items: The smoke and carbon monoxide detectors were tested and are operable. There was a fully charged fire extinguisher observed. Resident/Staff records stored inside the locked filing cabinet. First Aid kit with required components, and a locked compartment for medication storage was observed. Emergency kits were observed inside the garage. The facility has a functioning telephone and line. There are no firearms and ammunition observed.

The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22. Based on the observations and evaluation of the facility this date, the facility is ready for licensure. LPA completed COMP III with the Licensee at the conclusion of the inspection.

Licensee will be notified once facility is licensed. An exit interview was conducted, and this report was discussed and provided to Licensee, Jessica Villanueva.

NAME OF LICENSING PROGRAM MANAGER: Nedra Brown
NAME OF LICENSING PROGRAM ANALYST: Michelle Echeverria
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC809 (FAS) - (06/04)

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