The Hills of Hayward

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management Deficiencies Visit while investigating a complaint. LPA arrived at 8am and was greeted by an uncleared staff member. At time of this report, a replacement staff member, that is background cleared and associated to the facility, arrived to provide care for the one resident residing at the facility at 2:30pm. The Licensees are being cited for the lack of oversight in providing an uncleared staff member to the facility. The licensee, shall exercise general supervision over the affairs of the licensed facility and to comply with the regulations to protect the residents in which they serve. LPA spoke with a witness and staff members regarding the care and supervision of the resident residing at the facility. During the visit LPA observed escalated behaviors and verbal abuse by the resident towards the LPA and staff members. Per interviews with witness and staff, the CAT team had arrived on August 7, 2026 and the Administrator (AD) Maricel Nepomuceno was the staff member working. Per staff, the Crisis Assessment Team (CAT) team had been called but, upon evaluation of the resident, did not send out the resident at this time since resident stopped exhibiting behaviors. The resident was assessed and licensees were told the resident needs a higher level of care due to the behaviors. The resident continues to reside at the facility. A deficiency for Incidental and Medical Care will be cited. Per Title 22, the licensee shall arrange, or assist in arranging, for medical care appropriate to the conditions and needs of residents. (Continued on LIC 809-C) (Continued from LIC 809) The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Administrator gave permission for the cleared staff member to sign the reports. An exit interview was conducted with Administrator Designee Heddy "Girlie" Mae Oyson and a copy of this report was given to the facility along with a copy of the LIC 809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Aug 20, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87205(a) · Plan of correction due date: Aug 31, 2026

87205 Accountability of Licensee Governing Body (a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the (Cont'd) individuals it serves. This requirement is not met as evidenced by: Based on LPA observations and interviews, Licensees did not ensure caregiver was background cleared which is a lack of oversight. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 20, 2026

Plan of correction: Licensee must be accountable for the facility operations and for the health, safety and personal rights of the residents they serve. Licensees shall provide a Memo of Understanding regarding the responsibilities, duties and accountability and provide the regulations reviewed. Licensees to email LPA of this signed statement and regulations reviewed by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(a)(1) · Plan of correction due date: Sep 18, 2026

87465 Incidental Medical and Dental Care a) A plan for incidental medical and dental care shall be developed...The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care...(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on LPA's observations and interviews, one of one resident is not receiving the medical care needed. This is a potential health and safety risk for the residentthe state’s words, verbatim · CDSS document, Aug 20, 2026

Plan of correction: Licensees and/or Administrator shall provide the appropriate level of care for one of one resident to meet the mental health needs of the resident that cannot be provided by the facility. LE and AD will notify the Department of the resident's change of condition, updated 602a and Appraisal Needs and Services Plan or relocation to an appropriate facility by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) made an unannounced Case Management Deficiencies Visit on August 20, 2026. LPA was greeted and granted entry by Staff and spoke with the Licensee (LE) Allen Medina and Designated Administrator Heddy "Girlie" Mae Oyson via phone. The facility has one resident and is under the care of one uncleared staff member. LPA confirmed with the Regional Office that the staff member has submitted paperwork but is pending clearance. An immediate Civil Penalty for $500 will be assessed for caregiver not being associated or background cleared. LPA spoke with LE Allen Medina that the staff member cannot be on the premises and the resident needs to be relocated. LPA obtained copies of the resident's: Identification and Emergency Information, Physician's Report, Reappraisal and Admissions Agreement. LPA interviewed three of three staff members and one resident. LPA observed resident spoke with Power of Attorney (POA) and refused to leave. During the tour LPA observed the facility had a pot with mold on the stove. The facility utilities have remained on and there is two days of perishable and seven days of non perishable food on hand. The toilet seat in the main bathroom was in disrepair and the second toilet in a vacant bedroom needed to be cleaned. On August 19, 2026 the facility was served an eviction notice by the landlord for non-payment. A deficiency will be cited for finances from 7/31 - 8/20/2026 at $100 per day X 21 days is $2100. Licensees were advised to notify resident responsible party with the eviction notice and relocation notice per Title 22 regulations. Total assessed $2100+$500 = $2600. An exit interview was conducted with Designated Administrator, Heddy "Girlie" Mae Oyson via phone and a copy of this report, LIC 809-Ds, LIC421FC and appeal rights were provided to the facility. The reports are unsigned due to the staff member at the facility being uncleared.the state’s words, verbatim · CDSS document, Aug 20, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.17(b)(1)(C) · Plan of correction due date: Aug 21, 2026

1569.17 (b) In addition to the applicant, the provisions of this section shall apply to criminal convictions of the following persons: (1) (C) Any person who provides client assistance in dressing, grooming, bathing, or personal hygiene...This requirement is not (cont'd) Based on LPA's Guardian review and interview the staff member has not been background cleared. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 20, 2026

Plan of correction: Licensee (LE) was notified and uncleared staff was relieved of duties pending a cleared staff member replacement.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Aug 31, 2026

(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 was not met as evidenced (cont'd) by: Based on LPA observations and interview the toilets in two of two bathrooms were in disrepair or unclean and a pot with mold was sitting on the stove. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 20, 2026

Plan of correction: AD stated someone will be sent to the facility to repair the toilet seats and clean. The pot with mold was cleaned during the visit. AD will text LPA photos by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert arrived unannounced for a Case Management Deficiencies visit. LPA was greeted and granted entry by staff at 2:45pm and explained the purpose of the visit. Licensee (LE) Maricel Nepomuceno was notified that LPA was in the facility. LE had prior commitments and could not come to the facility. LPA observed the facility was 74 degrees Fahrenheit and all utilities were in working order and were not shut off. The bathroom hot water temperature was 107.3 degrees Fahrenheit. The refrigerator had two days of perishable food items and seven days of non perishable food on hand. The facility was clean and there were no odors detected. There is currently one resident in care. LPA reviewed the resident's record and interviewed the resident regarding care provided. Two of two staff stated they were recently paid from 7/1-7/15/2026 on 7/22/2026 but are still owed back pay. A penalty will be assessed for finances due to back pay being owed from 7/10-7/30/2026. The penalty amount is $100 per day X 21 days for a total of $2100. LPA was informed that the Licensee (LE), Maricel Nepomuceno, is now the Administrator at this location. An exit interview was conducted with Staff #1 (S1) and a copy of this report was given to the facility along with a copy of the LIC 858 and LIC421FC.the state’s words, verbatim · CDSS document, Jul 30, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management visit. LPA was greeted and granted entry at 11am and spoke with the Administrator (AD) Heddy "Girlie" Mae Oyson via phone and explained the purpose of the visit. The facility is a four bedroom, three bathroom residential home with an approved fire clearance of six non-ambulatory residents and for one bedridden resident in room #1. The facility has a hospice waiver for five residents. Currently there are two residents in care and both receive hospice services. During the visit, LPA toured the facility and observed the temperature was 77 degrees Fahrenheit. The hot water temperature was measured at 105.2 degrees Fahrenheit. Utilities and appliances are operational. The facility retained two days of perishable supplies and seven days of non perishable food on hand. The facility was clean and there were no odors detected. LPA spoke with one of two residents and two of two staff members. Resident stated they receive proper care. Two of two staff interviewed continued to be owed back pay. A Civil Penalty of 21 days X $100 per day will be assessed for CCR 87213 Finances. Total assessed is $2100 for the dates 6/18-7/9/2026. An exit interview was conducted with Staff #1 (S1) and a copy of this report and LIC 421FC was provided to the facility.the state’s words, verbatim · CDSS document, Jul 9, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a Case Management Deficiencies Visit. LPA was greeted and granted entry by Staff #1 (S1) at 11:15am. LPA was informed by staff that one resident moved out this morning and that a second resident will be moving out at the end of the month. LPA observed one resident was being fed lunch by staff, one was being visited by hospice. LPA interviewed two of two staff regarding pay. Two of two staff are currently owed back pay. A Civil Penalty will be assessed for Finances CCR 87213 from 5/30-6/18/2026 at $100 per day x 20 days. Total assessed $2000. LPA spoke with the Administrator over the phone who confirmed two residents will be moved out by the end of the month. LPA observed the facility posted the legal proceedings from the Department. Legal notice was posted on the bulletin board at the entryway. AD stated the Licensees are in the process of selling the business at this location. LPA relayed to AD that business license is not transferable and explained the process for a Change of Ownership. The Department received notice that a new operator will be purchasing the home's license and that, "...CDSS gave us a 90-day window to sell of 10 RCFE's...and CDSS will grant the license to them expeditiously." A deficiency will be cited for False Claims CCR 87207. LPA toured the facility which was 73 degrees Fahrenheit. The water temperature in the bathroom was 105.3 degrees Fahrenheit. The facility retained two days of perishable items and seven days of non-perishable items. LPA interviewed two of two residents regarding care provided. (Continued on LIC 809-C) (Continued from LIC 809) The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Staff #2 for Administrator Heddy "Girlie" Mae Oyson and a copy of this report was given to the facility along with a copy of the 809-D, LIC 421FC, and Appeal Rights.the state’s words, verbatim · CDSS document, Jun 18, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87207 · Plan of correction due date: Jul 18, 2026

87207 False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidenced by: (cont'd) LPA was informed verbally and observed documentation stating the Department will expedite and grant a license to a new operator. This poses a potential health and safety risk for three of three residents in care.the state’s words, verbatim · CDSS document, Jun 18, 2026

Plan of correction: AD will speak with Licensees to provide information to residents, staff, vendors and families that are not misleading statements that misrepresent the Department. The Department is in legal proceedings and there are no agreements agreed upon between CDSS and licensees at this time.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a Case Management Deficiencies Visit. LPA was greeted and granted entry by Staff #1 at 1pm. LPA spoke with both Administrator, Heddy "Girlie" Mae Oyson and Licensee Allen Medina via phone. LPA explained the purpose of the visit. LPA toured the facility and observed the Department Legal Notice was not posted in a prominent place in the facility. LPA provided the document to staff to post on a bulletin board by the front door and a deficiency and immediate civil penalty will be assessed. . LPA asked if families were notified of the Department's legal proceedings with the Hills Two of two staff and two of two residents were not informed and were notified verbally by LPA. A deficiency will be cited and a civil penalty assessed. Two of two resident Responsible Parties (RPs) were contacted via phone by LPA. A message was left with an additional RP and LPA was unable to leave a message with the last RP. LPA observed utilities are operational. There are two days of perishable items and seven days of non-perishable items. The hot water temperature was 105.3 degrees Fahrenheit. The facility was clean, no odors were detected and the temperature was 73 degrees. Two of two staff members currently have not been paid. Staff are to be paid on the 7th and 22nd of each month. A citation and immediate civil penalty will be assessed for $250. Total Civil Penalties assessed is $1250. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Staff #1 for Administrator Heddy "Girlie" Mae Oyson and a copy of this report was given to the facility along with a copy of the 809-D, LIC 421IMs, lIC 421FC and Appeal Rights.the state’s words, verbatim · CDSS document, May 29, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(b)(1) · Plan of correction due date: May 29, 2026

§1569.38. Posting of licensing reports; disclosure to new residents. (b) A licensed residential care facility for the elderly shall provide written notice to a resident, the resident’s responsible party, if any, and the local long-term care ombudsman, within 10 days from the occurrence of either of the (cont'd) following events: (1) The department commences proceedings to suspend or revoke the license of the facility pursuant to Section 1569.50. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, May 29, 2026

Plan of correction: Licensee shared with LPA that notices were being mailed to North County facilities' families via certified mail today.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.38(e) · Plan of correction due date: May 30, 2026

§1569.38 (e) Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility, that may include where the mail boxes are located, where the facility license (cont'd) is posted, or any other easily accessible location in the facility. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, May 29, 2026

Plan of correction: Licensee was informed by LPA that a copy of the Accusation was provided to the facility and staff posted in a prominent location by the front door.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: May 30, 2026

87213 The licensee shall have a financial plan that [...] assures sufficient resources to meet operating costs for care of residents; shall maintain adequate finances. Based on interviews conducted, the Licensee did not ensure employees are receiving their paychecks timely or the full amount. This poses an immediate health and safety risk for persons in care. CIVIL PENALTY ASSESSEDthe state’s words, verbatim · CDSS document, May 29, 2026

Plan of correction: The Licensee will be working on W-2 paperwork for staff payments and re-submit a financial plan to the Department by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management visit. LPA was greeted and granted entry by Staff #1 (S1) and spoke with Administrator (AD) Heddy "Girlie" Mae Oyson via phone. AD was unable to meet LPA and was in a meeting with Licensees (LEs). The facility has four residents in care. One resident was being visited by family, one resident was reading in their room, a third resident was watching television in their bedroom and the fourth resident was asleep. LPA observed all bedrooms had the required furnishings and linens and there were no odors detected. LPA interviewed three of three residents regarding care being provided. Three of four residents were clean and dressed for the day. The fourth resident was being bathed during the visit. The hot water temperature tested at 113.9 degrees Fahrenheit. During the visit, LPA toured the facility. The facility has a minimum of two days of perishable food items and seven days of non-perishables. Utilities have remained on and there is ample food supply for the residents. LPA interviewed two of two staff who stated their next pay date will be on May 22, 2026 and that all pay and back pay owed are current. The facility was 74 degrees Fahrenheit and was clean. The facility has current liability insurance and the exterior is being maintained. LPA shared with AD, via phone, that legal notices sent by certified mail from the Department must be posted in the facility and families notified within ten days. AD acknowledged this and will follow-up with Licensees. Based on LPA's interviews and observations, the facility is in Compliance with Title 22 Regulations and no deficiencies will be cited on this date. An exit interview was conducted with Staff #1 (S1) for AD Oyson and copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 15, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management visit. LPA was greeted and granted entry by Staff #1 (S1) at 10:10am. Administrator (AD) was informed of LPA's presence. Currently there are four residents in care and all four are on hospice. The facility has an approved hospice waiver for five. LPA toured the facility and interviewed two of four residents. A third resident was being visited by a family member and the ombudsman and the fourth resident was asleep. All residents were clean, dressed and comfortable. The facility was clean and odorless. Two of two staff were preparing lunch and feeding residents during the visit. The facility freezer and pantry have seven days of non-perishable food items and the refrigerator has two days of perishable items. Fruit was observed on the counter and two of two residents were happy with meals. All utilities and appliances were operational. The facility was 77 degrees Fahrenheit. LPA tested the hot water temperature in the one resident bathroom. The hot water temperature was 109.3 degrees Fahrenheit. Two of two staff interviewed confirmed they were paid and that Friday, May 8th is the last Friday they will be paid. Staff will then be paid bi-monthly on the 7th and 22nd of each month. Two of two staff stated they have no back payments owed and all payments are current. The facility has liability insurance and a financial plan was submitted to the Department on May 9, 2026. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Staff #2 for Administrator (AD) Heddy "Girlie" Mae Oyson and a copy of the report was provided to the facility.the state’s words, verbatim · CDSS document, May 6, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management Visit to conduct a health and safety visit of residents in care. LPA was greeted and granted entry by Staff #1 at 10:15am and spoke to Administrator (AD) via phone regarding the purpose of the visit. There are currently four residents in care. The refrigerator had more than two days of perishable items and freezer and pantry had seven days of non-perishable items. Utilities are in working order and all appliances are operational. The facility was 70 degrees Fahrenheit. The hot water temperature in the resident bathroom was 109.2 degrees Fahrenheit. LPA conducted a health and safety check on the four residents in care. LPA interviewed two of four residents who were awake. Two of the four residents were asleep in their bedrooms but were clean and dressed with no odors detected. LPA interviewed three of three staff members. Three of three staff members confirmed they have received full payment of back wages owed; as well as current wages. Staff are now paid weekly. Thus, the Plan of Correction for a deficiency cited on 2/21/2026 has been cleared on this date. LPA received the Certificate of Liability Insurance for the facility and the Plan of Correction was cleared on April 13, 2026. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Staff #2 for Administrator (AD) Heddy "Girlie" Mae Oyson and a copy of the report was given at the time of the visit.the state’s words, verbatim · CDSS document, Apr 21, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert conducted a Case Management visit for a health and safety check for residents in care. LPA was greeted and granted entry by Staff #1 (S1) at 10:30am and there are four residents in care. Administrator (AD) was unable to meet with LPA but communicated via phone. At time of visit, LPA observed staff making BBQ ribs, rice and vegetables for lunch. LPA interviewed two of two staff members who shared that they currently are paid and back-pay is almost paid back in full. Staff were paid on April 9, 2026 for 3/30-4/5-2026. A Civil Penalty will be assessed for $100 X 10 days for $1000 from 3/31-4/9/2026 due to a repeat violation for Finances. LPA asked Administrator if the facility has current liability insurance. Currently the facility does not have liability insurance. A Civil Penalty will be assessed for $100 X 10 days for $1000 from 3/31-4/9/2026 due to a repeat violation for liability insurance. Total assessed is $2000. LPA interviewed two of four residents. All residents were dressed and clean The third of four residents was sleeping and the fourth resident had a visitor and was being fed. There were two-days of perishable items and seven-days of non-perishable food on-hand. The house was 73 degrees Fahrenheit and the air conditioner was operational. The hot water temperature in the resident bathroom is 105.9 degrees Fahrenheit. Cable and internet were working and utilities have remained on. The exterior of the property was maintained and there are no obstructions in outdoor pathways. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Staff #1 for Heddy "Girlie" Mae Oyson, Administrator and a copy of this report was given to the facility along with a copy of the LIC 421-FCs.the state’s words, verbatim · CDSS document, Apr 9, 2026

Type of visit: Case Management - Deficiencies

LIcensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management visit for a resident health and safety check on March 30, 2026. LPA was greeted and granted entry by Staff #1 (S1) at 10:30am. The facility temperature was 73 degrees and all utilities were observed to be in working order. The refrigerator had two-days of non-perishable supplies and the facility retained seven-days of non-perishable items. The resident bathroom hot water temperature was measured to be 113.5 degrees Fahrenheit. During the visit, LPA conducted a health and safety check on the five residents in care. LPA observed two of two staff in the kitchen preparing for lunch and one resident was having a meeting with an outside vendor. Two of the five residents were napping before lunch and two of the five residents were interviewed and relaxing in their bedroom. The facility was clean and residents were dressed and groomed for the day. LPA observed Staff #2 (S2) was present for work after taking some time off. LPA asked two of two staff if they have been paid for services and two of two staff stated they have been partially paid. A deficiency and Civil Penalty has been issued for 87213 Finances from March 25, 2026 to March 30, 2026. The amount assessed is $100/day X 6 days for a total amount of $600. The facility does not have current liability insurance. A Civil Penalty has been issued for Health and Safety Code 1569.605 from March 25, 2026 to March 30, 2026. The amount assessed is $100/day X 6 days for a total amount of $600. Total amount assessed is $1200. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Staff #2 for Heddy "Girlie" May Oyson, Administrator (AD) and a copy of this report was given to the facility along with a copy of the LIC 421-FCs.the state’s words, verbatim · CDSS document, Mar 30, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert came unannounced to conduct a Case Management visit. LPA was greeted and granted entry by Staff #1 (S1) at 1:45pm. LPA spoke with Administrator (AD) Heddy "Girlie" Mae Oyson via phone regarding the purpose of the visit. The facility temperature was 73 degrees Fahrenheit and air conditioning, power, water/trash and cable internet were in working order. The facility retained two days of perishable food and seven days of non-perishable food. The hot water temperature in the resident bathroom was 114.1 degrees Fahrenheit. At time of visit, one staff member was present providing care for the five residents. The Administrator (AD) had recently left to go to another facility but will return to work as the second staff member at this time. LPA spoke with AD and requested a staff plan to ensure there is enough staff to provide services necessary to meet residents' needs. A citation will be given. LPA also asked if liability insurance is current for the facility. AD stated the liability insurance is not current at this time. Civil Penalties will be assessed for not having liability insurance from 3/20-3/24/2026 for five days X $100/day = $500. LPA interviewed three of three residents regarding care. Two of three residents confirmed there is one staff member that provides the care in the facility. Residents stated the utilities have remained on and the staff member is able to meet the residents needs. Two of the five residents in care were sleeping in their rooms. LPA knocked on the door and one smiled and waved and promptly went back to sleep. Both residents were dressed, clean and comfortable. (Continued on LIC 809-C) (Continued from LIC 809) Two of two staff shared that they were fully paid for the pay period of 2/4-2/18/2026. Staff were partially paid for the pay period of 2/19-3/15/2026 and expect to be paid the second payment on Wednesday, March 25th. A staff member has left due to financial distress. Civil penalties will be assessed for 87213 Finances for 3/20-3/24/2026 for five days X $100/day = $500. Total amount assessed is $1000. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Staff #1 for Heddy "Girlie" May Oyson, Administrator (AD) and a copy of this report was given to the facility along with a copy of the LIC 809-D, Appeal Rights and LIC 421-FCs.the state’s words, verbatim · CDSS document, Mar 24, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Mar 25, 2026

87411(a) (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...The licensing agency may require any facility to provide additional staff whenever it determines...that the needs of the...residents,the extent of services provided...require...additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on LPA observations and interviews there is one staff to five residents; which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: LPA spoke with Administrator (AD) to submit a Staff Plan to ensure there is enough staff to provide services necessary to meet residents' needs. AD will email LPA by end of visit today.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a Case Management visit to the facility on March 19, 2026. LPA spoke with Administrator (AD) Heddy "Girlie" Mae Oyson via phone and explained the purpose of the visit. AD was unable to meet LPA due to a conflicting appointment. LPA toured the kitchen and observed there was two-days perishables in the refrigerator and seven-days of non-perishable items. Groceries were delivered on Tuesday. The facility utilities were in working order and was a comfortable 74 degrees and the hot water temperature in the resident bathroom was 113.7 degrees Fahrenheit. The facility was clean and odorless and cable TV and internet were operational. LPA conducted a health and safety visit with the five residents in care. Four of five residents were happy with the care being provided by the staff, the quality of the food and stated utilities remain on. One of five residents is not able to communicate but was observed being fed lunch by staff. LPA spoke to three of three staff. One of three staff members was fully paid for 2/4-2/18/2026. Two of three staff members were partially paid for the pay period of 2/4-2/18/2026. The next pay period is for 2/19-3/15/2026 and payroll will be distributed on 3/22/2026. Per Licensees and Administrator, the pay period has been adjusted to be on the 7th and 22nd of each month. Money is still owed to staff from 2/4-2/18/2026. Civil penalties will be assessed for 87213 Finances.for 3/12-3/19/2026 for eight days X $100/day = $800. The facility does not have current liability insurance. Civil Penalties will be assessed for not having liability insurance from 3/12-3/19/2026 for eight days X $100/day = $800. Total amount assessed is $1600. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Staff #1 for Heddy "Girlie" May Oyson, Administrator (AD) and a copy of this report was given to the facility along with a copy of the LIC 421-FCs.the state’s words, verbatim · CDSS document, Mar 19, 2026

Type of visit: Case Management - Deficiencies

LIcensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a Case Mangement and Health and Safety Visit. LPA was greeted and granted entry by Staff #1 (S1) at 3pm. Administrator Heddy "Girlie" Mae Oyson arrived at 4pm.The facility temperature was 74 degrees and the hot water temperature in the bathroom was 109.4 degrees Fahrenheit. The facility was clean and staff were preparing dinner. LPA interviewed three of three staff who shared the utilities have remained on. LPA toured the facility and observed the refrigerator had two-days of perishable items and seven days of non-perishable items. LPA did a health and safety check of the five residents in care. One resident was being visited by a family member, another resident interviewed with LPA, two residents were sleeping and one resident was watching the news on their tablet. All residents were groomed and dressed. Three of three staff members were interviewed regarding payroll. One of three staff members was fully paid for 2/4-2/18/2026. One of three staff members got a partial payment of money owed from 2/4-2/18/2026. One of three staff members did not get paid anything for 2/4-2/18/2026. Civil penalties will be assessed for 87213 Finances.for 3/6-3/11/2026 for six days X $100/day = $600. The facility does not have current liability insurance. Civil Penalties will be assessed for not having liability insurance from 3/6-3/11/2026 for six days X $100/day = $600. Total amount assessed is $1200. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Heddy "Girlie" May Oyson, Administrator (AD) and a copy of this report was given to the facility along with a copy of the LIC 421-FCs.the state’s words, verbatim · CDSS document, Mar 11, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation and Case Management visit. LPA was greeted and granted entry by Staff #1 at 1:05pm. LPA met with Administrator (AD) Heddy "Girlie" Mae Oyson and explained the purpose of the visit. The facility is a single story, four bedroom residence with an approved fire clearance of six non-ambulatory residents of which one may be bedridden. The licensee has an approved hospice waiver for six. The facility currently has a census of five residents in care and all five residents receive hospice services. During today’s visit, LPA toured the facility and inspected and tested all smoke detectors. Smoke and carbon monoxide detectors were operational. The temperature in the facility was 76 degrees. All utilities such as air conditioning, gas, water/trash were operational The facility has two bathrooms but one bathroom is designated for residents; the other bathroom is off the kitchen and is only used by staff. LPA tested the hot water temperature in the resident bathroom. The hot water temperature measured 106.8 degrees Fahrenheit. The bathroom had grab bars and covered trash cans. LPA observed the fire extinguisher was charged and was serviced on October 4, 2024. The facility’s last fire drill was conducted on February 8, 2025 and a deficiency will be cited. A fire drill in-service was conducted during LPA's visit. LPA inspected the kitchen and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand Additional food is stored in the garage with emergency supplies. Sharps and knives were secured in a locked drawer and chemicals and cleaning supplies were secured underneath the kitchen sink. The PUB 475 poster was observed in the kitchen. LIC 500, Infection Control, Visiting Hours, Facility sketches and Disaster Plan (Continued on LIC 809-C) (Continued from LIC 809) were posted in hallway. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. A First Aid Kit and manual is on the premises. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on June 10, 2026. LPA reviewed two of two staff training and fingerprint records and conducted a complete review of resident records. Two of two staff records did not have required annual training. The last training on record was on January 24, 2025. A citation was given on January 28, 2026 with a plan of correction for February 27, 2026. Civil penalties will be assessed from 2/28/26 to 3/05/2026 for six days X $100/day = $600 for staff not being currently trained. Two of five residents needed updated Medical Assessments. One of five residents did not have a Medical Assessment. A citation was given on January 28, 2026 with a plan of correction date of February 27, 2026. Civil penalties will be assessed from 2/28/26 to 3/05/2026 for six days X $100/day = $600 for medical assessments.. LPA spoke with Licensee, Maricel Nepomuceno regarding current liability insurance. The liability insurance is currently pending. A citation was given on 2/24/2026. Civil penalties will be assessed from 2/25-3/5/2026 for nine days X $100/day = $900 for liability insurance. LPA interviewed three of three staff who confirmed they have not been paid for the pay period of 2/4-2/18/2026. Staff will be paid on March 7, 2026. A citation was given on February 20, 2026. Civil penalties will be assessed from 2/21-3/5/2026 for 13 days X $100/day = $1300 for finances. The following failure to correct and Type A deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Total civil penalties assessed is $3,400. An exit interview was conducted with Heddy "Girlie" Mae Oyson, Administrator and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D, Appeal Rights and LIC 421FCs.the state’s words, verbatim · CDSS document, Mar 5, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced Case Management visit to conduct a health and safety check on the residents in care. LPA was greeted and granted entry by Staff 1 (S1). Administrator (AD), Heddy "Girlie" Mae Oyson was notified by phone that LPA was at the facility. LPA asked if the facility had current liability insurance, Administrator stated that is it being taken care of by the Licensee. The Administrator could not provide proof of liability insurance. LPA and Staff 1 toured the facility. LPA observed the facility has electricity, gas and water service. LPA observed the See Something Say Something poster (PUB 475) posted in the dining room/kitchen. The poster is visible from the front door. The living room has a fireplace that is screened. LPA observed a 2 day perishable and a seven day non-perishable food supply on hand in the kitchen. Medication is locked in cabinet in the dining room. Hot water measured 117.6 degrees Fahrenheit in the shared bathroom in the main hallway. LPA observed all resident rooms have the required furniture. LPA observed all bathrooms are clean and operational. LPA interviewed Staff 1, Staff 2 and Staff 3 who reported they were paid last Friday. LPA interviewed 2 out of 5 residents who reported no issues and stated staff are always available to assist. 3 residents were sleeping during the visit. LPA observed 2 beds in the patio room which is next to the living room. Staff reported they live/sleep in the patio room. LPA toured the exterior of the facility. No bodies of water observed. LPA observed weeds in the backyard. Staff confirmed there has not been gardening service since December 2025. Both exit gates are operational. No obstacles or hazards observed in the backyard. No obstacles or hazards observed in the facility. Smoke detectors/carbon monoxide detectors tested operational. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations and Health and Safety Code. A Civil Penalty of $250 is being assessed for Failure to Correct/Repeat Violation. An exit interview was conducted via phone with Heddy "Girlie" Mae Oyson, Administrator. AD gave permission for Staff #1 (S1) to sign licensing reports. A copy of this report was given to the facility along with a copy of the LIC 811, LIC 421-FC, LIC 809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Feb 24, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Feb 27, 2026

§1569.605 Liability insurance; coverage requirements: On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests in the amount of at least...($1,000,000)...per occurrence and...($3,000,000)... caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Based on LPA file review and interview with Administrator the facility does not have current liability insurance. This poses an immediate health and safety risk to all residents in carethe state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: Licensee (LE) agrees to have the required insurance and to provide proof to the Agency (CCL) by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(2)(B) · Plan of correction due date: Mar 3, 2026

No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building. This requirement is not being met as evidenced by LPA observed and staff reported they sleep/live in the patio room next to the living room. This poses a potential health,safety and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: Licensee agrees to not allow anyone to sleep in any room except for bedrooms and to have staff no longer sleep/live in the patio room next to the living room. Licensee to sign a statement of understanding CCR 87307 and to forward proof to the Agency (CCL) by the POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management visit to conduct a health and safety check on the residents in care. LPA was greeted and granted entry by Staff #1 (S1) at 1:00pm. Administrator (AD), Heddy "Girlie" Mae Oyson was notified by the staff that LPA was at the facility and contacted LPA via phone. When asked about current liability insurance, AD deferred for LPA to contact Licensee. During the visit LPA observed there were two-days of perishable food and seven-days of non-perishable food on-hand. Both refrigerator/freezer units were fully stocked with a variety of fruits and vegetables. LPA confirmed all utilities were operational; which include: electricity, water/trash, gas/heat and cable/internet/phone. The facility was clean and there were no odors detected. LPA conducted a health and safety check for the five residents in care. Residents were observed in their bedrooms relaxing or napping after lunch. All residents were groomed and dressed. Two of five residents were sleeping and LPA interviewed three awake and alert residents. Three of the five residents confirmed they had plenty of food, that the utilities have not been shut-off and the staff provide for their care needs. Three of five residents interviewed had no issues with care being provided. LPA interviewed three of three staff members. Three of three staff confirmed they had not been paid for the past pay period. AD shared with LPA that staff checks were in AD's possession and that she would courier the checks to the facility while the LPA was present. Checks arrived prior to 3pm and staff deposited via mobile phone apps. Checks were on hold or pending so funds were not available. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured the exterior of the property and observed the front lawn to be overgrown. Staff confirmed there has not been gardening service since December 2025. The backyard is concrete and all pathways were clear of hazards and obstruction. LPA confirmed the lease payment for February was paid timely. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations and Health and Safety Code. A Civil Penalty of $250 is being assessed for Failure to Correct/Repeat Violation.. An exit interview was conducted via phone with Heddy "Girlie" Mae Oyson, Administrator. AD gave permission for Staff #1 (S1) to sign licensing reports. A copy of this report was given to the facility along with a copy of the LIC 811, LIC 421-FC, LIC 809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Feb 20, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 21, 2026

87213 Finances. The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents. This requirement is not met as evidenced by: Based on LPA observation and staff interviews, the facility staff have not been paid for two pay periods. This poses an immediate health and safety risk for all residents in care.the state’s words, verbatim · CDSS document, Feb 20, 2026

Plan of correction: Licensee (LE) was currently creating employee accounts in the new payroll account opened with US Bank. LE stated employees should be paid by Monday, 2/23/2026. During the visit, partial payments were sent via courier to staff. Staff attempted to deposit but payment (Cont'd) was put on hold and funds were not available.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.605 · Plan of correction due date: Feb 21, 2026

§1569.605 Liability insurance; coverage requirements: On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests in the amount of at least...($1,000,000)...per occurrence and...($3,000,000)... caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Based on LPA file review the facility does not have current liability insurance. This poses an immediate health and safety risk to all residents in care.the state’s words, verbatim · CDSS document, Feb 20, 2026

Plan of correction: Licensee (LE) stated new insurance contracts were obtained on Wednesday, 2/18/2026 and that once all contracts are paid, LE will forward all documentation to LPM Santos and LPA Lopez.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management visit to conduct a health and safety check for the residents in care. LPA was greeted and granted entry by Staff #1 (S1) at 12:30pm. LPA met with Administrator (AD) Heddy "Girlie" Mae Oyson and explained the purpose of the visit. The facility currently has five residents in care. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. All utilities were in working order and appliances were operational. A grocery delivery was expected to arrive today. While touring the facility, LPA conducted a health and safety check for five of five residents in care. Three of five residents were napping after eating lunch. Two of five residents were interviewed and stated they did not have any issues and that everything was fine. LPA interviewed three of three staff members regarding care provided or any issues with the facility. LPA obtained copies of the resident and staff rosters and the following documents from five of five residents' records: Identification and Emergency Information forms (LIC 601), Physician's Reports (LIC 602A), Resident Appraisals (LIC 603A), hospice paperwork and Admissions Agreements. Records were taken by the LPA for copying since the facility copier was not in working order at time of visit. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Heddy "Girlie" Mae Oyson, Administrator and a copy of the report was given at the time of the visit.the state’s words, verbatim · CDSS document, Feb 5, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) made an unannounced case management visit to return resident records listed on the Confidential Names Report (LIC 811). LPA was greeted and granted entry by Adora Capa, staff at 2:56pm. Per California Code of Regulations 87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. LPA returned five of five resident records which include: Identification and Emergency Information forms (LIC 601), Physician's Reports (LIC 602A), Resident Appraisals (LIC 603A), hospice paperwork and Admissions Agreements. Staff member, Adora Capa, confirmed receipt of the original documents for five of five residents. An exit interview was conducted with Adora Capa and a copy of this report and LIC 811 were provided to the facility.the state’s words, verbatim · CDSS document, Feb 5, 2026

Allegation investigated: Staff did not complete a health screening

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry by staff at 8am. LPA spoke with Administrator, Eli Cuyson, via phone and explained the purpose of the visit. LPA reviewed and obtained copies of four of four staff records. Four of four staff had the following: Personnel Record (LIC 501), Health Screening Report with Tuberculosis readings (LIC 503), Criminal Record Statement (LIC 508), current First Aid and Cardiopulmonary Resuscitation (CPR) training and are fingerprint cleared through the Department. Based on LPA record review, observations and interviews, the allegation is false, could not have happened, and/or is without a reasonable basis. Thus the allegation that Staff did not complete a health screening is Unfounded. An exit interview was conducted, via phone, with Administrator Eli Cuyson. A copy of this report was provided to the facility. Unfoundedthe state’s words, verbatim · CDSS document, Jan 28, 2026 · control 22-AS-20260126153807

Allegation investigated: Staff did not complete required training Resident records are incomplete Administrator not present at the facility a sufficient number of hours Facility is in financial distress

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry by staff at 8am. LPA spoke with Administrator, Eli Cuyson, via phone and explained the purpose of the visit. The facility has a census of five residents in care and conducted a health and safety check for all residents in care. LPA reviewed and obtained copies of four of four staff records. Four of four staff had the following: Personnel Record (LIC 501), Health Screening Report with Tuberculosis readings (LIC 503), Criminal Record Statement (LIC 508), current First Aid and Cardiopulmonary Resuscitation (CPR) training and are fingerprint cleared through the Department. Staff training records were reviewed and the last documented monthly in-service was conducted on January 24, 2025. Thus the allegation that staff did not complete required training is Substantiated. (Continued on LIC 9099-C) Substantiated (Continued from LIC 9099) LPA reviewed five of five resident records. Two of five residents, Residents #2 and #3, did not have medical assessments on file and one resident, Resident #1, has not had a medical assessment since October 22, 2024. Resident #1 has a diagnosis of Senile Degeneration of the Brain, Dementia. Staff #1 contacted Administrator (AD) who also stated the paperwork could be with hospice. Thus, three of five resident records had old or missing medical assessments. The allegation that Resident records are incomplete is Substantiated. LPA interviewed three of three staff members and the Administrator (AD) regarding the number of hours the AD is present at the facility. Three of three staff members could not confirm that the AD was present for, at the minimum twenty hours, required weekly at the facility. LPA spoke with the AD who, at the present, oversees multiple facilities and was told an Administrator would be assigned to this location. The Personnel Record (LIC 500) was not updated. Thus the allegation that Administrator not present at the facility a sufficient number of hours is Substantiated. At time of entry, at 8am, facility did not have cable/internet services. LPA spoke with AD and CEO regarding this and, because of the change of management, there have been transition issues with accessing utilities. LIcensee is assisting in transitioning utility account information and access to the new management, Lotus Senior Housing and are working to pay any outstanding bills that were not paid. LPA toured the facility and observed the phone was working, power was on, there was water and gas and heater was operational. Cable/ internet was operational at 9:15am. LPA spoke with five of five residents and all stated they were doing fine and there were no issues. Residents and family members have received notice of the management change and a Change of Ownership is currently in process. Thus, the allegation that the Facility is in financial distress is Substantiated at this time. Based on LPA interviews, record review and observations, the preponderance of evidence standard has been met. Therefore the above allegations: Staff did not complete required training, Resident records are incomplete, Administrator not present at the facility a sufficient number of hours and the Facility is in financial distress are Substantiated. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Eli Cuyson, Administrator (AD) via phone with Staff #1 (S1) designated to sign the reports and a copy of this report was given to the facility along with a copy of the LIC 9099-D, LIC 858, LIC 859 and Appeal Rights.the state’s words, verbatim · CDSS document, Jan 28, 2026 · control 22-AS-20260126153807

From the deficiency page — Deficiency type: Type A · Section cited: CCR 82713 · Plan of correction due date: Jan 29, 2026

87213 Finances. The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents. This requirement is not met as evidenced by: Based on LPA observation and staff interviews, the cable/internet bill was not paid and was shut-off for two days. This poses an immediate health and safety risk for the five of five residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: The Chief Executive Officer (CEO) of Lotus Senior Housing was contacted and the cable/Internet was turned on at 9:15am. CEO stated that the new management is transitioning utilities from all the Hills facilities and are working to have all bills paid and current. AD will email LPA updated payments for facility by end of business January 29, 2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: Feb 27, 2026

87412 Personnel Records ( c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement was not met as evidenced by: Based on LPA review of four of four personnel records and in-service training, staff training was not documented since January 24, 2025. This poses a potential risk for residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: Administrator (AD) will provide monthly in-services for staff and will document training and send to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Feb 27, 2026

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. This requirement was not met as evidenced by: Based on LPA review of five of five resident records, two of five residents did not have a medical assessment on file.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: AD will obtain Medical Assessments for two of five residents. AD will email LPA the two Medical Assessments by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Feb 27, 2026

87405 Administrator - Qualifications and Duties (a) ll facilities shall have a qualified and currently certified administrator... The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility...This requirement is not met as evidenced by: Based on LPA interviews, AD is not at facility for a sufficient number of hours. This poses a potential risk for residents health and safety in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: A designated Administrator (AD) shall be assigned to the facility that can provide the sufficient number of hours to manage operations. Licensee to submit paperwork for AD or Administrator Designee by POC date to LPA.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced case management visit at the facility to conduct a resident health and safety check. LPA was granted entry by staff and spoke with Administrator, Eli Cuyson, via telephone regarding the purpose of the visit. There are currently five residents in care. At time of LPA's arrival, at 10am, the facility was experiencing a power outage. Administrator Cuyson was aware and had contacted the office regarding getting electricity repaired or turned on. Electricity turned off at 9:20am and power returned at 10:50am for a duration of one hour and thirty minutes. There were two family members visiting at this time. LPA conducted a health and safety check of all residents in care. Three of three residents were interviewed, and two of two residents were sleeping. LPA obtained the Identification and Emergency Information forms, Medical Assessments and hospice information for all residents. Residents were clean, fed and had no problems with care. One resident required oxygen during the night but a portable oxygen tank was available, if needed. There is no generator on-site. LPA contacted licensee for mitigation plans, in case of prolonged power outage. LPA toured the facility and observed a grocery delivery service arriving. When electricity was turned back on, LPA observed the refrigerator had more than two days of perishable supplies and there were seven days of non-perishables. Water, gas, and phone/internet services were in working order. Appliances were also operational. (Continued on LIC 809-C) (Continued on LIC 809) LPA interviewed five of five staff members regarding the duration of the outage. In December 2025 there was an internet/phone outage but that was resolved. Staff stated this was the first time the electricity has turned off but the gas, water, phone and internet services were working. Staff are being paid for care provided. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Eleazar "Eli" Cuyson, and a copy of this report was given to the facility along with a copy of LIC 809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Jan 8, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Jan 9, 2026

87213 Finances. The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents. This requirement is not met as evidenced by: Based on LPA observation and staff interviews, the electricity bill was not paid and was shut-off for one hour and thirty minutes. This poses an immediate health and safety risk for the five of five residents in care.the state’s words, verbatim · CDSS document, Jan 8, 2026

Plan of correction: The Director of Operations contacted the office and the electricity bill was immediately paid. Electricity was turned on at 10:50am.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87205(a) · Plan of correction due date: Jan 9, 2026

87205 Accountability of Licensee Governing Body (a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement was not met as evidenced by: Based on LPA observations and interviews power was shut-off due to non-payment. This poses an immediate health and safety risk for five of five residents in care.the state’s words, verbatim · CDSS document, Jan 8, 2026

Plan of correction: Administrator stated that there is an immediate change of management, effective today. The accountability of licensee will be a new entitiy who has the financial resources to oversee the facility's operations.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management visit on October 30, 2025. LPA was greeted and granted entry by Staff #1 and explained the purpose of the visit. Currently the facility has a census of three residents in care. LPA requested copies of residents' Identification and Emergency Forms, Physician's Reports and Admission Agreements. LPA conducted a health and safety check on the three residents in care. During the course of the visit LPA toured the facility which was clean and there were no odors detected. Utilities were on and appliances were in working order. LPA observed the refrigerator and two freezers were full with a variety of fruits and vegetables; as well as frozen meats. Pantry was stocked with canned goods and emergency food supplies were also observed. The facility orders food every Monday and food is delivered weekly. LPA conducted a health and safety check and interviewed three of three residents regarding their quality of care and interviewed three of three staff regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on May 27, 2026. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Eli Cuyson, Administrator and a copy of the report and files reviewed (LIC 858) were given at the time of the visit.the state’s words, verbatim · CDSS document, Oct 30, 2025

Allegation investigated: Facility is in financial distress

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit for a complaint received in the Regional Office. LPA spoke with Administrator (AD) Eli Cuyson via telephone regarding the purpose of the visit and AD gave permission for staff member, Adora Capa, to sign the licensing reports. It is alleged that the facility is in financial distress. LPA conducted a health and safety visit with the four residents in care. Three of four residents were sleeping at time of visit at 9:45am. LPA interviewed one of four residents, Resident #1 (R1) who had just eaten breakfast and stated R1 had no issues regarding food or care. LPA also interviewed two of two staff members who stated payroll has been paid and utilities were working. LPA toured the facility and observed food items in the refrigerator and cupboards. Freezers had plenty of food for the facility. LPA obtained a copy of the staff and resident rosters and September staff schedule. AD Eli Cuyson spoke with Licensee (LE) Maricel Nepumuceno who would email monthly bills and rent paperwork to LPA. (Continued on LIC 9099-C) Substantiated (Continued from LIC 9099) LPA obtained documentation that rental payment was not received in a timely manner and funds were not available for payment on the due date of September 5, 2025. Based on record review and email communications, payment was submitted on September 5, 2025 by Licensee but it did not post or show pending status. Witness interview stated that the funds were not available on the due date and that Licensee, Allen Medina, confirmed this in email communication that the payment bounced back. The rent payment had to be re-submitted on September 11, 2025 and was received on September 12, 2025. Based on LPA record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation that the facility is in financial distress is Substantiated. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Eli Cuyson and Adora Capa, Staff member and a copy of this report was given to the facility along with a copy of the LIC 811, LIC 9099-D and Appeal Rights.the state’s words, verbatim · CDSS document, Sep 16, 2025 · control 22-AS-20250911082349

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87213 · Plan of correction due date: Oct 3, 2025

87213 Finances. The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and 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 upon the written request of the licensing agency. This requirement is not met as evidenced by: Based on LPA document review, rent payment did not have funds available and bounced back. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 16, 2025

Plan of correction: ADCuyson and LEs Nepomuceno and Medina spoke with LPA on a three way call regarding POC plan and date. AD and LEs will provide inservice to office staff regarding financial record documentation and payment procedures. AD and LEs will email LPA ACH information by POC due date

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Hanna Gough conducted an unannounced health and safety visit to the facility. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. The facility currently has four residents in care. During the visit, LPA toured the facility and spoke with residents in care. The facility appears clean, safe and sanitary. Residents appeared clean and well taken care of. Residents verbalized satisfaction with facility care and food. LPA observed a seven day non-perishable and two day perishable food supply on hand. LPA observed the emergency food and water supply at the facility. LPA observed extra food storage in the garage with a full fridge and freezer. No health or safety concerns noted during the visit. LPA obtained staff and resident roster. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 20, 2025

Type of visit: Office

On today's date, Licensing Program Managers (LPM) Alisa Ortiz and Licensing Program Analysts (LPAs) Michael Tea and Brandon Lopez met with Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy on this day for the purpose of discussing financial operations and distress and reporting requirements The following was discussed: Licensee's responsibilities of facility oversight Licensee's requirement to maintain control of facility and property Licensee’s responsibility to maintain financial solvency Licensee’s responsibility to communicate with the department Report of suspected dissolution of partnership Report continued on LIC809-C The following was agreed upon during today's meeting: The Licensee has clarified the dissolution of partnership is not related to license, but rather a separate business deal. The dissolution of partnership will not impact licensee’s facilities. The Licensee has reported they are in communication with landlords for properties leased and will maintain a valid lease and control of property. The Licensee will maintain payment of all facilities bills and ensure sufficient staffing to meet residents needs, the Licensee will communicate any health and safety concerns related to residents in care to the department immediately. The following items are to be provided to the Department: Updated LIC 500 Personnel Report identifying all current working staff and their agreed upon schedules by close of business May 29, 2025. Updated lease agreements with letters from landlords voiding any outstanding evictions or unlawful detainers by close of business May 23, 2025. A copy of loan contract to support financial solvency by close of business May 29, 2025. An exit interview was conducted Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy. A copy of this report, LIC 809, was provided to Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy.the state’s words, verbatim · CDSS document, May 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 8am. During today’s visit, LPA met with Diane Mahinay Administrator. The facility is a single story residence with an approved fire clearance of six non-ambulatory residents of which one may be bedridden. There are four resident bedrooms, two resident bathrooms and a caregiver area off of the living room. The licensee has an approved hospice waiver for six. The facility currently has a census of six residents in care and all six receive hospice services. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits, . The hot water temperature measured between 104.3 and 118.4 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational. The fire extinguisher is charged and was serviced on October 4, 2024. The facility’s last fire drill was conducted on January 21, 2025. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. LPA observed a First Aid kit with the required elements and American Red Cross binder. The PUB 475 poster was observed in kitchen. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on May 15, 2026. (Continued on LIC 809-C) (Continued from LIC 809) Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Diane Mahinay, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Mar 18, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with designated Administrator (AD) Marciel Nepomuceno. An application to operate a Residential Care Facility for the elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by CCL on 4/24/2023. At 11:50 a.m. LPA toured the facility and observed the following: · The bed with pillows, linen, and blankets and staffs' personal belongings in the garage have been removed. Designated AD stated garage will solely be used for storage. Component III: was conducted during this inspection, information provided about how to operate the facility within compliance and reporting requirements. The facility is ready to be licensed. The designated AD was 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 left at the facility.the state’s words, verbatim · CDSS document, Mar 15, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with designated Administrator (AD) Marciel Nepomuceno. An application to operate a Residential Care Facility for the elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by CCL on 4/24/2023. Structure: The facility is a one-story house with four client bedrooms, two full size bathrooms, one half bathroom, a living room, kitchen, dining room, enclosed patio, and attached two car garage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the kitchen. There is a backyard with one designated exit gate on one side of the house. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. Resident Bedrooms All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. Signal system There is no signal system. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored and locked in the garage. Medications, First-Aid Kit & Book: Medication will be stored in a locked cabinet. First aid kit is stored in the pantry area. The first aid kit has all the required elements. Resident & Staff Files: Records will be kept in a locked cabinet. Pool/Jacuzzi: No bodies of water were observed. Fire Extinguisher: Fire extinguisher is fully charged with service tag dated 10/11/2023. Reading Material, Games, Equipment & Materials: The facility has reading books, activity books, board games, and other recreational materials for resident use stored in the living room. Fire clearance: Was approved by a fire inspector of Anaheim Fire Department on 12/07/2023. Special conditions noted, “Bedroom #1 for bedridden and bedroom door shall self-close at all times.” Bedrooms Staff: There is no staff bedroom. Bathrooms: All bathrooms have working plumbing. Hot water measured between 108.3-113.5 degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen was stored in the hallway storage. Emergency Phone Numbers, Exit Plan & Menu: Posted and available, means of exiting, and emergency phone numbers. Food menu is posted and visible. Food Service: A supply of 2-day perishable and 7-day of non-perishable food was observed. Smoke Detectors: Smoke detectors and carbon monoxide detectors tested operational. Appliances: Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. Licensee to address the following corrections by 03/16/2024: LPA observed a section of the garage to be sectioned off with wall dividers. The area contains a made bed with pillows, linen, and blankets and also contains staffs' personal belongings. Designated AD stated bed and belongings would be removed as garage is solely used for storage. LPA will make an additional announced visit to follow-up on corrections listed above. An exit interview was conducted, and a copy of this report was provided to designated AD.the state’s words, verbatim · CDSS document, Mar 8, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Name - Allen Medina CEO/ Maricel Nepomuceno Administrator Interview Method: Telephone interview On January 26, 2024, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-Licensing Readinessthe state’s words, verbatim · CDSS document, Jan 26, 2024