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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006133
Report Date: 02/24/2026
Date Signed: 02/24/2026 03:57:57 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/18/2026 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20260218135245
FACILITY NAME:HILLS OF ROCKAWAY, THEFACILITY NUMBER:
306006133
ADMINISTRATOR:JOANNA GOMEZFACILITY TYPE:
740
ADDRESS:919 E ROCKAWAY DRIVETELEPHONE:
(909) 450-1699
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 5DATE:
02/24/2026
UNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Adrian Brucal - Staff TIME COMPLETED:
04:25 PM
ALLEGATION(S):
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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
INVESTIGATION FINDINGS:
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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
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 22-AS-20260218135245
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HILLS OF ROCKAWAY, THE
FACILITY NUMBER: 306006133
VISIT DATE: 02/24/2026
NARRATIVE
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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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/18/2026 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20260218135245

FACILITY NAME:HILLS OF ROCKAWAY, THEFACILITY NUMBER:
306006133
ADMINISTRATOR:JOANNA GOMEZFACILITY TYPE:
740
ADDRESS:919 E ROCKAWAY DRIVETELEPHONE:
(909) 450-1699
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 5DATE:
02/24/2026
UNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Adrian BTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Staff do not ensure that calls from resident's authorized representative are
returned in a timely manner
INVESTIGATION FINDINGS:
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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 that calls from resident's authorized representative are returned in a timely manner, the investigation revealed the following:

It was alleged that staff do not ensure that calls from resident's authorized representative are
returned in a timely manner. It was reported that both Licensee Allen Medina and Maricel Nepomuceno did not respond to calls from family, per interview with Administrator Girlie she denies that Licensees have not responded to authorized representatives in a timely manner currently. AD stated cannot speak to previous to her employment which stated in late Janurary 2026.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20260218135245
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HILLS OF ROCKAWAY, THE
FACILITY NUMBER: 306006133
VISIT DATE: 02/24/2026
NARRATIVE
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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.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20260218135245
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HILLS OF ROCKAWAY, THE
FACILITY NUMBER: 306006133
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/08/2026
Section Cited
CCR
87468.1(a)(9)
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(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.
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Licensee to create a policy regarding responding to authorized representatives in a timely manner and provide policy to LPA by POC due date.
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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.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5