The Hills of Rockaway

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Administrator (AD) Girlie Oyson and the purpose of the inspection was discussed. During today’s inspection, LPA conducted a tour of the facility and observed the facility currently has a zero census. All bedrooms were observed to be free of any personal belongings. LPA observed utilities, including water, gas, and electricity are no longer operational and a notice from the Yorba Linda Water District was received on July 29, 2026 indicating services would be shut off due to non-payment. During interview, AD stated their wages are currently paid in full. LPA observed notice of Department commencing proceedings to revoke the license of the facility posted in the entranceway. Deficiency cited under Title 22 Regulation 87213 pertaining to Finances has not been cleared as Licensee did not comply with the POC. Deficiency is being re-cited. Based on observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Aug 6, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Aug 7, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155... and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: Licensee to provide all records to LPA via email by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Staff Adrian Brucal and the purpose of the inspection was discussed. During today’s inspection, LPA observed the facility currently has a zero census. Per Staff Brucal, all residents have relocated to either their personal home or a different care facility. LPA conducted a tour of the facility and observed all bedrooms to be free of any personal belongings. LPA observed utilities, including water, gas, and electricity to be operational. During interview, Staff stated their wages were partial and incomplete for the last pay period. LPA observed notice of Department commencing proceedings to revoke the license of the facility posted in the entranceway. Deficiency cited under Title 22 Regulation 87213 pertaining to Finances has not been cleared as Licensee did not comply with the POC. Deficiency is being re-cited. Based on observations made during today’s inspection, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Jul 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Jul 18, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155... and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 17, 2026

Plan of correction: Licensee to provide all records to LPA via email by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Staff Danilo "Dany" Caberio and the purpose of the inspection was discussed. During today’s inspection, two of three facility residents were observed to be sleeping. One of three residents was observed to be awake and having breakfast consisting of eggs, toast, and fruit. Resident was interviewed and stated they did not have any concerns. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. Water temperature tested at 108.3 degrees Fahrenheit. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. During their interview, one of one staff present stated they have been paid full and complete wages, utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. LPA observed notice of Department commencing proceedings to revoke the license of the facility posted in the entranceway. Deficiency cited under Title 22 Regulation 87213 pertaining to Finances has not been cleared as Licensee did not comply with the POC. Deficiency is being re-cited. Based on observations made during today’s inspection, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Jun 15, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Jun 16, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155... and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 15, 2026

Plan of correction: Licensee to provide all records to LPA via email by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Staff Adrian Brucal and the purpose of the inspection was discussed. During today’s inspection, all three facility residents were observed to be sleeping. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. Water temperature tested at 108.3. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. During their interview, two of two staff stated they have been paid full and complete wages and are currently paid up to date. Per two of two staff, utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. Deficiency cited under Health and Safety Code 1569.605 pertaining to Liability Insurance has been cleared as LPA was provide with a copy of current liability insurance. Deficiency cited under Title 22 Regulation 87213 pertaining to Finances has not been cleared as Licensee did not comply with the POC. Deficiency is being re-cited. Administrator (AD) Heddy Oyson was contacted by phone and informed that legal notices sent via certified mail by the Department must be posted in the facility and residents notified within ten days. AD stated they had yet to receive legal notices by mail, however, stated they understood and would inform LPA once legal notices were received. Based on observations made during today’s inspection, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, May 18, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: May 19, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155... and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 18, 2026

Plan of correction: Licensee to provide all records to LPA via email by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Staff Joey Sarmiento and the purpose of the inspection was discussed. During today’s inspection, residents were observed to be sleeping in their respective bedrooms. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. Water temperature tested at 111.2 degrees Fahrenheit. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. During their interview, two of two staff stated they have been paid full and complete wages and are currently paid up to date. Per two of two staff, utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. Deficiency under Health and Safety Code 1569.605 pertaining to Liability Insurance has not been cleared and will be re-cited as Licensee did not comply with POC. Deficiency under Title 22 Regulation 87213 pertaining to Finances has not been cleared and will be re-cited as Licensee did not comply with the POC. Based on observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, May 6, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: May 7, 2026

On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as liability insurance for the facility is not currently being maintained, which poses an immediate safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 6, 2026

Plan of correction: Liability insurance will be obtained and a copy provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87213 · Plan of correction due date: May 7, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155... and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 6, 2026

Plan of correction: Licensee to provide all records to LPA via email by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Staff Joey Sarmiento and the purpose of the inspection was discussed. During today’s inspection, residents were observed resting in their respective bedrooms and having breakfast. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. During their interview, two of two staff stated they have been paid full and complete wages and are currently paid up to date. Per two of two staff, utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. Deficiency cited under Title 22 Regulation 87303 pertaining to Maintenance and Operation has been cleared as flooring in the room 3 is no longer uneven. Deficiency cited under Health and Safety Code 1569.605 pertaining to Liability Insurance has not been cleared, as Licensee did not comply with POC. CIVIL PENALTY IS BEING ASSESSED. Deficiency cited under Title 22 Regulation 87213 pertaining to Finances has not been cleared as Licensee did not comply with the POC. CIVIL PENALTY IS BEING ASSESSED. Deficiency cited under Title 22 Regulation 87211(d)(4) pertaining to Reporting Requirements has not been cleared as Licensee did not comply with the POC. CIVIL PENALTY IS BEING ASSESSED. (Cont. LIC809-C) Based on observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Civil penalties are also being assessed, see LIC421FC. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Apr 14, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Apr 15, 2026

On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as liability insurance for the facility is not currently being maintained, which poses an immediate safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 14, 2026

Plan of correction: Liability insurance will be obtained and a copy provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87213 · Plan of correction due date: Apr 15, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155... and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 14, 2026

Plan of correction: Licensee to provide all records to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(d)(4) · Plan of correction due date: Apr 15, 2026

(d) The licensee shall notify.. all residents, and... their representatives, in writing within two business days of any of the following... (4) The licensee receives a written notice of default of payment of rent... This requirement is not met as evidenced by: Based on record review, Licensee did not comply with the section cited above as they have not provided any written notice to any resident or their family, which poses an immediate personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 14, 2026

Plan of correction: Licensee to provide written notice to residents and their representatives of default on the mortgage for the facility and a copy of written notice to residents will be provided to LPA via email by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Staff Adrian Brucal and the purpose of the inspection was discussed. During today’s inspection, residents were observed resting in their respective bedrooms and watching television in the living room. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. During their interview, one of two staff stated they were paid late and incomplete wages for the last pay period and stated they were unsure when they would be paid in full. One of two staff stated they have been paid up to date. Per two of two staff, utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. Deficiency cited under Health and Safety Code 1569.605 pertaining to Liability Insurance has not been cleared, as Licensee did not comply with POC. CIVIL PENALTY IS BEING ASSESSED. Deficiency cited under Title 22 Regulation 87213 pertaining to Finances has not been cleared as Licensee did not comply with the POC. CIVIL PENALTY IS BEING ASSESSED. Deficiency cited under 87211(d)(4) pertaining to Reporting Requirements has not been cleared as Licensee did not comply with the POC. CIVIL PENALTY IS BEING ASSESSED. (Cont. LIC809-C) Based on observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Civil penalties are also being assessed, see LIC421FC. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Apr 6, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Apr 7, 2026

On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as liability insurance for the facility is not currently being maintained, which poses an immediate safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 6, 2026

Plan of correction: Liability insurance will be obtained and a copy provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87213 · Plan of correction due date: Apr 7, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155... and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 6, 2026

Plan of correction: Licensee to provide all records to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87211(d)(4) · Plan of correction due date: Apr 7, 2026

(d) The licensee shall notify.. all residents, and... their representatives, in writing within two business days of any of the following... (4) The licensee receives a written notice of default of payment of rent... This requirement is not met as evidenced by: Based on record review, Licensee did not comply with the section cited above as they have not provided any written notice to any resident or their family, which poses an immediate personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 6, 2026

Plan of correction: Licensee to provide written notice to residents and their representatives of default on the mortgage for the facility and a copy of written notice to residents will be provided to LPA via email by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Staff Joey Sarmiento. LPA met with Staff Yumi Lumuthang and the purpose of the inspection was discussed. During today’s inspection, residents were observed resting in their respective bedrooms. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. LPA observed there is uneven flooring in room 3, posing a tripping hazard. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. During their interview, two of two staff stated they were paid late and incomplete wages for the last pay period and stated they were unsure when they would be paid in full. Per two of two staff, utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. Deficiency cited under Health and Safety Code 1569.605 pertaining to Liability Insurance has not been cleared, as Licensee did not comply with POC. CIVIL PENALTY IS BEING ASSESSED. Deficiency cited under Title 22 Regulation 87213 pertaining to Finances has not been cleared as Licensee did not comply with the POC. CIVIL PENALTY IS BEING ASSESSED. Deficiency cited under 87211(d)(4) pertaining to Reporting Requirements has not been cleared as Licensee did not comply with the POC. CIVIL PENALTY IS BEING ASSESSED. Based on observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Civil penalties are also being assessed, see LIC421FC. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Apr 1, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Apr 2, 2026

On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by Based on record review, the Licensee did not comply with the section cited above as liability insurance for the facility is not currently being maintained, which poses an immediate safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 1, 2026

Plan of correction: Liability insurance will be obtained and a copy provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87213 · Plan of correction due date: Apr 2, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155... and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 1, 2026

Plan of correction: Licensee to provide all records to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(d)(4) · Plan of correction due date: Apr 2, 2026

(d) The licensee shall notify.. all residents, and... their representatives, in writing within two business days of any of the following... (4) The licensee receives a written notice of default of payment of rent... This requirement is not met as evidenced by: Based on record review, Licensee did not comply with the section cited above as they have not provided any written notice to any resident or their family, which poses an immediate personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 1, 2026

Plan of correction: Licensee to provide written notice to residents and their representatives of default on the mortgage for the facility and a copy of written notice to residents will be provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Apr 8, 2026

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include... procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, the Licensee did not comply with the section cited above as uneven flooring was observed in room 3, which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 1, 2026

Plan of correction: Licensee to ensure flooring is made even and no longer posing a tripping hazard, and provide LPA with picture proof via email by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Staff Adrian Brucal and the purpose of the inspection was discussed. During today’s inspection, residents were observed having breakfast and watching television in the living room. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. Water temperature tested at 105.9 degrees Fahrenheit. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. Interviews were conducted with two staff and facility residents. During their interview, two of two staff stated they have been paid up to date, facility utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. Deficiency cited under Health and Safety Code 1569.605 pertaining to Liability Insurance has not been cleared, as Licensee did not comply with POC. CIVIL PENALTY IS BEING ASSESSED. The Department requested the Licensee to provide the following by 3 p.m., February 6, 2026: Records from October 2025 through January 2026, including financial records and staff payroll records. As of today’s date, the full extent of the records requested were not received by the Department. Deficiency cited under Title 22 Regulation 87213 pertaining to Finances has not been cleared as Licensee did not comply with the POC. CIVIL PENALTY IS BEING ASSESSED. (Cont. LIC809-C) On March 18, 2026, Licensee notified the Department that on March 5, 2026, they received notice of default on the mortgage for the facility due to only one mortgage payment being made from October 2025 to March 2026, which was for November 2025, and they are now five months behind on mortgage payments. Per Licensee, if they do not pay the five months in full by March 31, 2026, the bank will start the foreclosure process. Licensee stated they have started to inform some of the residents’ families via telephone, but they have not provided any written notice to any resident or their family. Based on observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Civil penalties are also being assessed, see LIC421FC. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Mar 24, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Mar 25, 2026

On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as liability insurance for the facility is not currently being maintained, which poses an immediate safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Liability insurance will be obtained and a copy provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87213 · Plan of correction due date: Mar 25, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155... and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee to provide all records to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(d)(4) · Plan of correction due date: Mar 25, 2026

87211 Reporting Requirements (d) The licensee shall notify the Department... all residents, and... their representatives, in writing within two business days of any of the following... (4) The licensee receives a written notice of default of payment of rent... This requirement is not met as evidenced by: Based on Licensee interview, Licensee did not comply with the section cited above as they received notice of default on the mortgage for the facility due to being five months behind on mortgage payments and they have not provided any written notice to any resident or their family.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee to provide written notice to residents and their representatives of written notice they received regarding default on the mortgage for the facility and a copy of written notice to residents will be provided to LPA via email by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Staff Joey Sarmiento and the purpose of the inspection was discussed. During today’s inspection, residents were observed having breakfast consisting of egg, bacon, hash browns, and fruit. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. Water temperature tested at 106.3 degrees Fahrenheit. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. Interviews were conducted with two staff and facility residents. During their interview, two of two staff stated they have been paid up to date, facility utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. LPA conducted file review for one of one resident files previously not available for review and observed file to be complete. Deficiency cited under Title 22 Regulation 87506(a) pertaining to Resident Records has been CLEARED as POC was met. At approximately 9:25 a.m., LPA spoke with Administrator (AD) Heddy "Girlie" Oysen by phone, who stated Liability Insurance has yet to be obtained. Deficiency cited under Health and Safety Code 1569.605 pertaining to Liability Insurance has not been cleared, as Licensee did not comply with POC. CIVIL PENALTY IS BEING ASSESSED. (Cont. LIC809-C) The Department requested the Licensee to provide the following by 3 p.m., February 6, 2026: Records from October 2025 through January 2026, including financial records and staff payroll records. As of today’s date, the full extent of the records requested were not received by the Department. Deficiency cited under Title 22 Regulation 87213 pertaining to Finances has not been cleared as Licensee did not comply with the POC. CIVIL PENALTY IS BEING ASSESSED. Based on observations made during today’s inspection, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Civil penalties are also being assessed, see LIC421FC. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Mar 18, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Mar 19, 2026

On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as liability insurance for the facility is not currently being maintained, which poses an immediate safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 18, 2026

Plan of correction: AD stated liability insurance will be obtained and a copy provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87213 · Plan of correction due date: Mar 19, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155... and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 18, 2026

Plan of correction: AD stated all records will be provided to LPA via email by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Staff Joey Sarmiento. LPA met with Staff Adrian Brucal and the purpose of the inspection was discussed. During today’s inspection, residents were observed resting in their respective bedrooms and watching television in the living room. LPA conducted record review for four of four resident files and observed one of four files to be incomplete and did not include an admission agreement, a medical assessment, or a pre-appraisal. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. Water temperature tested at 106.8 degrees Fahrenheit. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable food. LPA observed liability insurance certificate for the facility to be expired and a current liability insurance certificate was not available for review. Interviews were conducted with two staff and facility residents. During their interview, two of two staff stated they were paid incomplete or partial wages from two pay periods ago and have not been paid for the last pay period at all, however, stated facility utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. The Department requested the Licensee to provide the following by 3 p.m., February 6, 2026: Records from October 2025 through January 2026, including financial records and staff payroll records. As of today’s date, the full extent of the records requested have not been received by the Department. Based on observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Mar 10, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Mar 11, 2026

On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as liability insurance for the facility is not currently being maintained, which poses an immediate safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 10, 2026

Plan of correction: Staff Brucal stated liability insurance will be obtained and a copy provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87213 · Plan of correction due date: Mar 11, 2026

87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155... and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 10, 2026

Plan of correction: Staff Brucal stated all records will be provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87506(a) · Plan of correction due date: Mar 10, 2026

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility... readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based upon record review, the Licensee did not comply with the section cited above in one of four resident records, which does not include an admission agreement, a medical assessment, or a pre-appraisal, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 10, 2026

Plan of correction: Staff Brucal stated resident's records were in transit to be delivered at the facility and a copy would be provided to LPA via email by POC date.

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 02/24/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit. Deficiency cited under Title 22 Regulation 87303(e)(2) pertaining to Water Temperature has NOT been cleared. Water temperature tested between 132.0 and 132.4 degrees F in facility restrooms. Licensee has NOT complied with the POC. CIVIL PENALTY ASSESSED. Deficiency cited under Title 22 Regulation 87213 pertaining to Finances has NOT been cleared. Facility did not provide proof of correction. Licensee has NOT complied with the POC. CIVIL PENALTY ASSESSED. Deficiency cited under Health and Safety Code 1569.605 pertaining to Liability Insurance has NOT been cleared. Licensee did not provide proof of correction. Licensee has NOT complied with the POC. CIVIL PENALTY ASSESSED. LPA toured the facility and observed ample two day perishables and seven day non-perishables. Utilities are operational during today's visit. There are 4 residents present today. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 2, 2026

Allegation investigated: Staff do not ensure facility has an adequate food supply Staff are unable to communicate with residents due to a language barrier Staff do not ensure resident is being assisted with dressing

On this Day, Licensing Program Analysts (LPAs) Andrea Mendivil and Kimberly Lyman made an unannounced visit to conduct a complaint investigation. LPAs were greeted and granted entry and explained the reason for the visit. The Department received a complaint on 02/18/2026. LPAs interviewed staff and residents. Regarding the allegations Staff do not ensure facility has an adequate food supply and Staff are unable to communicate with residents due to a language barrier , staff do not ensure resident is being assisted with dressing and, the investigation revealed the following: It was alleged the facility does not retain a minimum of 2 day perishbles and 7 day non-perishbles food on hand. LPAs observed the facility to have 2 refridgerators and a kitchen pantry with food available. It was alleged the staff is unable to communicate with residents due to lanaguage barrier, per interviews with 3 staff present and 1 staff via phone LPAs were able to communicate with staff without issue. Unsubstantiated It was alleged that staff do not ensure resident is being assisted with dressing, per interviews with 3 out of 4 staff deny leaving residents in the same clothing all day. Interview with 1 out of 4 staff stated they did not change resident's clothing due to residents not having pajamas. Per observation LPA Mendivil along with staff viewed all resident's bedtime clothing. Interviews with Administrator Heddy "Girlie" Oyson stated she has talked to the staff about changing residents before bed. LPA Mendivil was unable to interview residents as they were not oriented to space and time or were asleep at the time of the visit. Therefore based on the preponderance of evidence through observations and interviews the allegations Staff do not ensure facility has an adequate food supply, Staff are unable to communicate are determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. No deficiencies cited. An exit interview was conducted and a copy of this report was provided. Interview with Licensee Allen Medina stated for the month of January 2026 they did not have a full time administrator and he was not responding to families. Therefore based on the preponderance of evidence through interviews the allegation that staff do not ensure that calls from resident's authorized representative are returned in a timely manner is determined to be SUBSTANTIATED, meaning the complaint allegation is valid and that a violation has occurred. The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8. An exit interview was conducted and a copy of this report and appeal rights was provided to the facility representative.the state’s words, verbatim · CDSS document, Feb 24, 2026 · control 22-AS-20260218135245

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(9) · Plan of correction due date: Mar 8, 2026

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(9) To have communications to the licensee from their representatives answered promptly and appropriately. This requirement was not met as evidence by Licensee stated staff did not respond resident's family for the month of Jan 2026. This poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: Licensee to create a policy regarding responding to authorized representatives in a timely manner and provide policy to LPA by POC due date.

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced health and safety case management visit. LPAs were greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPAs toured the facility and observed the following: Facility appears clean and sanitary. Utilities are functional during today's visit including electricity, gas and water. Residents are relaxing in their rooms or in the living room watching television. LPAs observed lunch service which included sandwiches and tater tots. LPAs observed two day perishables and seven day non-perishables as well as emergency food and water. LPAs observed there is uneven flooring in room 3 presenting a fall risk for residents (photo). Water temperature was tested between 130.4 and 130.8 degrees F in facility restrooms. Interviews with staff indicated the staff were still owed wages from their last paycheck and were unsure when the wages owed would be paid. Staff were unable to provide a copy of the liability insurance as requested. Based on observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided.the state’s words, verbatim · CDSS document, Feb 24, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 25, 2026

87213 Finances: The licensee shall have a financial plan that conforms to the requirements of Section 87155, .. and that assures sufficient resources to meet operating costs for care of residents.. This requirement is not met evidenced by: Based on interviews conducted, the Licensee did not have an adequate financial plan in place to ensure staff are paid on schedule, Staff are still owed wages from the last pay period. This poses an immediate health and safety risk to persons in care. Civil Penalty Assessed.the state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: Licensee to submit a financial plan outlining how to meet the operating costs of the facility including paying wages to staff and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(e)(2) · Plan of correction due date: Feb 25, 2026

Faucets used by residents for personal care.. shall deliver hot water... hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This req is not met as evidenced by: Based on observation, Licensee failed to ensure hot water was between 105 and 120 degrees F. Water temperature measured between 130.4 and 130.8 degrees F in facility restrooms which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: Licensee to adjust water temperature and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Mar 10, 2026

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 req is not met as evidenced by: Based on observation, Licensee failed to ensure facility was safe for residents. LPAs observed an uneven floor in room 3 which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: Licensee to repair/ replace flooring in room 3 and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.605 · Plan of correction due date: Mar 10, 2026

On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by Based on interviews conducted, the Licensee did not comply with the section cited above as facility was unable to provide a copy of liability insurance, which poses a potential health and safety risk to persons in care. CIVIL PENALTY ASSESSEDthe state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: Licensee to forward a copy of liability insurance to LPA by POC due date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA met with Staff Chester Gutierrez and the purpose of the inspection was discussed. Administrator (AD) Girlie Oyson arrived at approximately 12:30 p.m. During today’s inspection, residents were observed having lunch consisting of a salad with chicken, a side of melon, and a cup full of juice. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. LPA observed liability insurance certificate for the facility to be expired. LPA spoke with Licensee Allen Medina by phone, who stated they were unable to provide LPA with a copy of current liability insurance as they were still in the process of obtaining it. Interviews were conducted with three staff and facility residents. During their interview, three of three staff stated they were paid incomplete or partial wages for the last pay period, however, stated facility utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. The Department requested the Licensee to provide the following by 3 p.m., February 6, 2026: Records from October 2025 through January 2026, including financial records and staff payroll records. As of the agreed upon due date, the full extent of the records requested were not received by the Department. Based on observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Feb 19, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 20, 2026

The licensee shall have a financial plan... that assures sufficient resources to meet operating costs...; shall maintain adequate financial records... and... submit... financial reports... upon... request of... licensing... This requirement is not met as evidenced by: Based on staff interviews, the Licensee did not comply with the section cited above as staff were paid incomplete wages and financial records and staff payroll records were not received by the Department, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 19, 2026

Plan of correction: Licensee stated all records will be provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.605 · Plan of correction due date: Feb 20, 2026

On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Based on Licensee interview, the Licensee did not comply with the section cited above as liability insurance for the facility is not currently being maintained, which poses an immediate safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 19, 2026

Plan of correction: Licensee stated liability insurance will be obtained and a copy provided to LPA via email by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA met with Staff Chester Gutierrez and the purpose of the inspection was discussed. During today’s inspection, residents were observed having lunch consisting of beef with veggies, rice, and watermelon. LPA conducted a tour of the facility and observed utilities, including water, gas, and electricity to be operational. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. Interviews were conducted with two staff and facility residents. During their interview, two of two staff stated they are currently being paid full and timely wages, facility utilities have been and continue to be operational, and food supply is and has been maintained at a two-day supply perishable and seven-day supply non-perishable. LPA obtained a copy of the following resident documents for five of five residents: Emergency Face Sheet, Physician Report, and Reappraisal. Administrator to provide LPA with a copy of five of five resident admission agreements by close of business on February 5, 2026. Based on observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Feb 4, 2026

Allegation investigated: Facility is in financial distress Insufficient staffing to meet residents' needs

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez for the purpose of delivering findings. LPA met with Staff Chester Gutierrez and explained the purpose of the inspection. Regarding allegation, Facility is in financial distress, the following was revealed: It is alleged the facility is in financial distress due to notice received from the water company indicating the water at the facility would be shut off, staff salaries not being paid, and food delivery being delayed due to bills not paid. Interviews were conducted with five facility residents and three staff. During their interview, three of five residents were unable to confirm or deny the allegation, however, stated the utilities at the facility have been and continue to be operational and food supply is always sufficient in quantity to meet their needs. Two of three residents were unable to confirm or deny allegations or indicate if there has been an interruption in utility services or if they are provided sufficient food in quantity. (Cont. LIC9099-C) Unsubstantiated During their interview, Staff 1 (S1) denied the facility is in financial distress and stated there have not been any interruptions to utility services at the facility. S1 stated all facility staff has been paid up to date and groceries are delivered to the facility on a weekly basis, with food supply being maintained at a 2-day supply perishable and 7-day supply of non-perishable food. During their interview, Staff 2 (S2) stated they have personally been paid up to date and stated to their knowledge all facility staff have been paid. Per S2, the utilities have been and continue to be operational and food supply is always maintained at a minimum of 2-day supply perishable and 7-day supply non-perishable food. S2 stated there was recently a change in the day of the week groceries are being delivered and stated groceries used to be delivered between Sunday and Monday and groceries are now delivered between Thursday and Friday. During their interview, Staff 3 (S3) stated they have personally been paid up to date and stated to their knowledge all facility staff have been paid. S3 stated the utilities have been and continue to be operational and food supply is always maintained at the minimum 2-day perishable and 7-day non-perishable food requirement. During the course of the investigation, the Yorba Linda Water District was contacted, and an interview was conducted with a Water District Representative, who denied the water at the facility would be shut off and stated there were no outstanding balances currently due as all bills have been paid to date. During initial 10-day inspection on January 22, 2026, LPA conducted a tour of the facility and observed all utilities were operational. LPA also observed a 2-day supply of perishable and a 7-day supply of non-perishable food and obtained the facility’s most recent grocery order, set for delivery on the following day, Friday, January 23, 2026, between 10 a.m. - 12 p.m. On January 23, 2026, LPA made an additional visit to the facility and observed groceries had been delivered and food supply exceeded 2-day supply of perishable and a 7-day supply of non-perishable food. Regarding allegation, Insufficient staffing to meet residents' needs, the following was revealed: It is alleged there is insufficient staffing to meet residents’ needs due to S2 being left alone all day and all night and a resident being feed meals without their dentures. During their interview, three of five residents denied the allegation and stated staff is always available to assist them. Two of three residents were unable to confirm or deny allegation. During their interview, S1 denied the allegation and stated there have not been any staff issues at the facility. During their interview, S2 stated there are always at least two staff present during shifts, except overnight, when there is only one staff on shift. S2 denied being left alone all day and stated there is sufficient staff to meet the needs of the residents. (Cont. LIC9099-C) During their interview, S3 denied any staffing issues and stated there is sufficient staff to meet the needs of the residents. Per S3, R3 wears dentures and on one particular morning, R3 did not have their dentures on at breakfast and staff immediately retrieved R3’s dentures from the solution they are kept in overnight. S3 stated this was an isolated event and staff had simply forgotten to put R3’s dentures in following their morning shower and was not due to lack of staffing. An interview was conducted with R3 on two separate occasions, however, R3 was unable to confirm or deny allegation. Based on observations made during complaint investigation and due to allegations being uncorroborated during interviews conducted, the Department is unable to determine if Facility is in financial distress or if there is Insufficient staffing to meet residents' needs. Although the above allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Jan 23, 2026 · control 22-AS-20260116102240

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit to the facility for the purpose of conducting a Case Management inspection. LPA was greeted and granted entry by Staff Bryllechester "Chester" Gutierrez. Administrator (AD) Joanna Gomez was notified via telephone, and the purpose of the inspection was discussed. LPA and Staff Gutierrez conducted a tour of the facility and observed the facility has electricity, gas, water, internet, and phone service. LPA observed the facility to have a two-day supply of perishable and a seven-day supply of non-perishable foods as required by regulation. Interviews were conducted with two staff and AD. During their interview, two of two staff and AD stated the utilities have been and continue to be operational, and food supply is maintained at a two-day supply perishable and seven-day supply non-perishable. AD stated they would obtain copies of facility utility bills paid to date, payroll records for facility staff, food receipts, and mortgage payment from Licensee for the months November and December 2025, and January 2026 and provide LPA with a copy via email by close of business on January 8, 2026. Based on observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Bryllechester "Chester" Gutierrez. Administrator (AD) Joanna Gomez was contacted by phone and the purpose of the inspection was discussed. AD arrived at the facility at approximately 9:30 a.m. During the inspection, LPA and Staff Gutierrez conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with four resident bedrooms, one staff room, two bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 113.7 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated August 13, 2025. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Medication was observed to be centrally stored and locked. A current copy of liability insurance was not available for review and AD was unable to provide LPA with a copy; a Deficiency was cited on today's date. LPA reviewed six of six resident files and three staff files. LPA interviewed three residents and two staff. Based on the observations made during today’s inspection, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Oct 29, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of following up regarding facility’s current resources to meet operating costs. LPA met with Administrator (AD) Joanna Gomez and the purpose of the inspection was discussed. Interviews were conducted with two staff and AD. During their interview, two of two staff and AD denied any knowledge of the facility’s current financial status and stated the utilities have been and continue to be operational, and food supply is maintained at two-day supply perishable and seven-day supply non-perishable. During today’s inspection, LPA observed a two-day supply of perishable and a seven-day supply of non-perishable foods. LPA conducted file review for six of six residents and observed four of six residents are currently on a special diet and special diets are being followed as directed per residents’ respective physicians. AD provided LPA with copies of facility utility bills paid to date. AD stated they would obtain copies of payroll records for facility staff, food receipts, and mortgage payment from Licensee for the months August, September, and October and provide LPA with a copy via email by close of business on October 30, 2025. Based on observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Oct 29, 2025

Allegation investigated: The facility does not have sufficient resources to meet operating costs for care of residents.

An office visit was scheduled on this day with Licensing Program Analyst (LPA) Rose Ruppert for the purposes of delivering findings into the above allegations. LPA met with Licensees Maricel Nepomuceno, Allen Medina and Keak Vongphakdy. It was alleged the facility does not have sufficient resources to meet operating costs for care of residents. The investigation determined as follows: The Department conducted an audit of the facility finances based on the Licensee’s 2024 Monthly Operating Statement. Per the review of facility finances, withdrawals exceeded deposits by $8,440.57 in January of 2024 which indicate a net loss. The amounts reported on the LIC 401 could not be directly traced to the bank statements and additional support was not provided by the licensee, therefore, reasonable assurance could not be provided that the facility is generating income to cover operating expenses for January 2024. A review of the facility bills and monthly mortgage payment appeared to show payments were being made timely, however, bills requested for two months had failed to be provided. (Continued on LIC 9099-C) Substantiated (Continued from LIC 9099) Bank statements were reviewed from the dates of February 2023 through January 2024. Bank statement showed no late fees or Non-Sufficient Funds (NSF) check charges. The only fees that were noted on the statements were service fees or wire transfer fees, both inbound and outbound. Many online transfers were observed, including large lump sums. Based on many of the large transactions and consistent payments, it appears the licensee has large amounts of liabilities. Therefore, based on records reviewed, it appears the licensee does not make sufficient income to cover operating expenses nor is there a sufficient cash reserve to cover operating expenses for one month. The licensee does not have a financial plan that complies with CCR Title 22 Section 87213, Finances. The allegation that facility does not have sufficient resources to meet operating costs for care of residents is deemed to be SUBSTANTIATED. The following is being cited per California Code of Regulations, Title 22. An exit interview was conducted with Maricel Nepomuceno, Allen Medina and Keak Vongphakdy and a copy of this report, LIC9099-D, and appeal rights was provided at the time of exit.the state’s words, verbatim · CDSS document, Jul 30, 2025 · control 22-AS-20230927113557

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Jul 31, 2025

87213 Finances. The licensee shall have a financial plan that conforms to the requirements of Section 87155, …that assures sufficient resources to meet operating costs for care of residents; may be required upon the written request of the licensing agency... This requirement was not met as evidence by: Licensee did not ensure financial plan implemented ensured income to cover operating expenses nor maintain sufficient cash reserves to cover operating expenses. This poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Jul 30, 2025

Plan of correction: The Licensees will self-certify understanding of financial requirements to operate facilities and send the statement and documentation to LPA by end of business, July 31, 2025. Licensees will update their financial plan for the long term to the Department as agreed per Non Compliance Conference (NCC).

Type of visit: Case Management - Deficiencies

An office visit was scheduled on this day with Licensing Program Manager (LPM) Alisa Ortiz and Licensing Program Analyst (LPA) Rose Ruppert for the purposes of delivering findings into complaint control number 22-AS-20230927113557. LPA met with Licensees Maricel Nepumuceno, Allen Medina and Keak Vongphakdy. During the course of the investigation, the following deficiencies were observed. During the course of the investigation, it was determined that the facility does not have sufficient resources to meet operating costs for care of residents. Furthermore, during the investigation the Licensee was asked to provide the Department requested documents by Friday September 6, 2024. After failing to meet the deadline, an extension was granted and the requested financial documents were to be provided by COB September 26, 2024. The Licensee failed to provide the requested documents by the extended deadline and later advised they were on jury duty and would work on providing the requested information that day. No plan was put in place at the time the Licensee was unavailable to ensure supervision over the affairs of the licensed facility in an effort to conform with the Department’s authority to audit and inspect records requested. As of Tuesday October 8, 2024, the documents had still not been received. After several more requests, the full requested documentation was not received as of Thursday October 17, 2024. To date, requested documents such as bills for July and August of 2023 & LIC403A Balance Sheet Supplemental Schedule. The following is being cited per Title 22. An exit interview was conducted with Maricel Nepumuceno, Allen Medina and Keak Vongphakdy. and a copy of this report, LIC809-D, and appeal rights was provided at the time of exit.the state’s words, verbatim · CDSS document, Jul 30, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87205(a) · Plan of correction due date: Jul 31, 2025

87205(a) Accountability of Licensee. 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: Licensee did not ensure policies were established to ensure records requested by the Department were provided during Licensees absence. This poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Jul 30, 2025

Plan of correction: Licensees will provide self-certification documentation Licensees understanding of role and need to ensure supervision over genal policies and procedures. Licensees to email LPA by end-of-business July 31, 2025. Licensees will update their quality ensurance plan for the long term to the Department as agreed per Non Compliance Conference (NCC).

Type of visit: POC

Licensing Program Analyst (LPA) Claudia Gutierrez conducted an unannounced Plan of Correction (POC) inspection. LPA was greeted and granted entry by Staff Aniceto "Ceto" Gabito. Administrator (AD) Joanna Gomez was contacted by phone and the purpose of the inspection was discussed. AD arrived at approximately 2:00 p.m. A deficiency was cited on June 20, 2025, during Case Management Health and Safety inspection. Deficiency 87303(a) was cited due to a plastic tube extending from a plumbing line on the side of the house into the yard draining sewage water, creating overflow from the yard onto the pathway in the backyard. During today’s visit, LPA and Staff Chester Gutierrez conducted a tour of the facility and observed there is no longer a plastic tube extending from the plumbing line on the side of the house draining sewage water into the yard and overflowing onto the pathway in the backyard. Per Staff Gutierrez, a pipe had been replaced and pointed to a section of newer concrete along the pathway from the backyard leading to the front of the house. Staff Gutierrez stated that the area had been dug up to replace the pipe and new concrete had been laid down after the pipe had been replaced and the plumbing system is now working as designed. LPA observed a dirt hole covered with a wood slab on the side of the house where the plastic tube had originally been connected to the pipeline. AD stated that the hole would be filled and covered in the coming days. Per AD, the dirt hole had been dug up on today’s date due to city permit requirements related to replacing the pipe. AD stated a copy of approved city permits will be provided to LPA via email by close of business on July 11, 2025. POC has been met and deficiency previously cited will be cleared. Based on today’s observations, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and was left at the facility.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of conducting a Health and Safety inspection. LPA was greeted and granted entry by Staff Ceto Gabito. Administrator (AD) Joanna Gomez arrived at 8:50 a.m. and the purpose of the inspection was discussed. During the inspection LPA and Staff Chester Gutierrez conducted a tour of the facility and observed the following: All resident bedrooms had the required furnishings. LPA observed resident beds had linens and blankets. LPA observed the facility has electricity, gas, water, internet and phone service. Water temperature tested between 104.9-109.2 degrees Fahrenheit, and faucets and toilets were operational. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated July 29, 2024. There is a backyard with a shaded sitting area. In the backyard LPA also observed a plastic tube extending from a plumbing line on the side of the house into the yard to allow for draining of sewage water, creating overflow from the yard onto the pathway; a Deficiency was cited on today’s date. Licensee to provide LPA with copies of facility current mortgage/lease payment and utility bills paid to date by close of business on June 23, 2025. Based on observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided to the facility.the state’s words, verbatim · CDSS document, Jun 20, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Jun 23, 2025

(a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with section cited above as there is a plastic tube extending from a plumbing line on the side of the house into the yard draining sewage water, creating overflow from the yard onto the pathway in the backyard which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 20, 2025

Plan of correction: AD stated that the plumbling line will be repaired immediately to drain as designed and the plastic tube removed. AD stated video proof will be provided to LPA via email by POC date.

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

On 12/07/2024 at 12:10 AM, Licensing Program Analyst LPA) Jose Calderon conducted an unannounced annual inspection visit at the Hills of Rockaway Home Facility. LPA Calderon was allowed entry into the facility by Administrator Allen Medina. Administrator Medina asked infection control questions and took LPA Calderon temperature prior to entrance into the facility. Facility is to operate a Residential Care Facility for 6 non-ambulatory Elderly residents 60 years or older. Currently, there are six (6) residents residing in the facility, 60 and older. LPA Calderon explained to Administrator Medina, the purpose of the one-year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: Six (6) client service records, six (6) client medication records (MAR), three (3) staff records, and inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on 09/09/2024. The one-story residential home consists of four (4) client bedrooms, two (2) client bathrooms, living room, dining room, kitchen, staff room, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. No weapons are stored in the premises. Kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water Storage is in the garage and kitchen area. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of client’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 106 degrees Fahrenheit; bathroom #2 hot water temperature properly measured at 108 degrees Fahrenheit. Kitchen hot water temperature properly measured at 110 degrees Fahrenheit. Facility (8) Carbon Monoxide and (8) Smoke Detectors hard wired operated and connected were tested and are working properly. The facility three (3) Fire Extinguishers was checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. The facility has a working landline telephone. All toxins and knifes are locked/secured and inaccessible to clients. Medications are centrally stored and in a locked storage cabinet. Facility 2 first aid kit is fully stocked with manuals was checked and in order. Outside grounds were toured and there is no water feature observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to clients. Six (6) client files were reviewed and found to be complete. LPA Calderon reviewed six (6) resident medications (MAR) and they were all found to be administered according to doctor's orders. Three (3) staff files were checked and have the required documents. LPA Calderon noted the Administrator Allen Medina Certification # 7015735740 expiration date of 04/11/2026 was valid at time of inspection. The facility does not handle client's money/cash resources and no surety bond is needed. Commercial General Liability Policy #PCI16931487501 policy period from 03/06/2024 to 03/06/2025 underwritten by Primary Care Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. Administrator Medina to email LPA Calderon a full copy of the commercial insurance policy including all endorsements no later than 12/20/2024. All the required documents are posted in the facility in a clearly visible area. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and clients, sanitizing stations (Located in common areas and restrooms). LPA observed staff and clients were NOT wearing face coverings. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA Calderon advised the Administrator Medina to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did observe deficiencies therefore citations were issued at this time. Annual Licensing Fee is CURRENT. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Allen Medina.the state’s words, verbatim · CDSS document, Dec 7, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on citation issued on 10/02/2023. LPA was greeted and granted entry into the facility and explained the reason for the visit. Administrator Jeff Bencito arrived during the visit. *Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has been cleared. Medications are secured during today's visit. Licensee has complied with the POC. Advisory note dated 10/02/2023 indicated the following: The front left burner on stove top is inoperable. Please repair/ replace. Emergency food supply appears low. Please ensure there is enough emergency food for all staff/ residents for at least 72 hours. During the visit, LPA observed facility replaced the stove and all burners work as well as an ample emergency food and water supply. Licensee has been advised to maintain compliance in all items previously cited. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 19, 2023

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced health and safety visit in conjunction with complaint #22-AS-20230927113557. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the complaint investigation, LPA toured the facility. LPA observed a clean and sanitary facility with ample food supply. At 10:40 AM, LPA observed pre-poured unsecured medications sitting on a counter in the kitchen as well as an unlocked cupboard containing medications. LPA observed residents relaxing or sleeping in the facility. All residents appeared clean and well taken care of. Residents verbalized satisfaction with facility services. LPA observed a clean and shaded outside area. Appliances are operational. Based on the observations made from today's visit, deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the Administrator and a copy was provided as well as Appeal Rights.the state’s words, verbatim · CDSS document, Oct 2, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Oct 3, 2023

Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not being met as evidenced by: Based on observation, Licensee failed to ensure centrally stored medications are inaccessible to residents in care. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 2, 2023

Plan of correction: Staff secured medications during visit.