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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006368
Report Date: 02/24/2026
Date Signed: 02/24/2026 04:50:12 PM

Document Has Been Signed on 02/24/2026 04:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:HILLS OF ORCHID, THEFACILITY NUMBER:
306006368
ADMINISTRATOR/
DIRECTOR:		NEPOMUCENO, MARICELFACILITY TYPE:
740
ADDRESS:20271 ORCHID STREETTELEPHONE:
(714) 430-7672
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY: 6CENSUS: 3DATE:
02/24/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:20 PM
MET WITH:Angelo SanguyoTIME VISIT/
INSPECTION COMPLETED:
05:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced Case Management visit to conduct a health and safety check on the residents in care. LPA was greeted and granted entry by Staff. The Administrator Eleazar Cuyson was notified by phone that LPA was at the facility. LPA asked if the facility had current liability insurance, Administrator stated that is it being taken care of by the Licensee and it should be acquired by Friday February 27, 2026. LPA verified with the Administrator that at this time the facility does not have insurance. The Administrator's certificate expires May 27, 2026. LPA and Staff toured the facility. Facility room temperature was 74.3 degrees Fahrenheit in the living room. LPA observed the See Something Say Something sign (PUB 475) posted in the living room. LPA observed the 5 burner gas stove lights unassisted. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. The kitchen is clean and organized. The fire extinguisher in the dining is room is fully charged. LPA interviewed 1 resident. Resident reported they have no issues and are doing well. 1 resident was not at the facility and 1 resident was asleep. LPA interviewed Staff 1 and Staff 2. Both staff members reported they are doing well and have no issues. Both staff members are background cleared and associated to the facility. LPA observed the bathrooms are clean and operational. Hot water measured 116.2 degrees Fahrenheit in the shared bathroom next to the living room. LPA observed all resident rooms had the required furnishings. LPA observed all resident rooms are clean and all beds have clean linen. Smoke detectors/carbon monoxide detectors tested operational. LPA and staff toured the upstairs. The upstairs has a loft and a staff bedroom and bathroom. No residents reside upstairs. LPA observed there is no evacuation chair next to the stairway. LPA observed the loft has a sofa and table. LPA toured the backyard. LPA observed there is a storage building in the backyard. LPA observed old furniture and boxes in the storage building. No bodies of water observed. Both exit gates on each side of the facility are operational. No obstacles or hazards observed in the backyard.
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Joseph Alejandre
LICENSING PROGRAM ANALYST 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.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 02/24/2026 04:50 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 02/24/2026 at 04:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HILLS OF ORCHID, THE
FACILITY NUMBER: 306006368

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/25/2026
Section Cited
HSC
1569.605

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HSC1569. 605 .... 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:
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Licensee agrees to have the required insurance and to provide proof to the Agency (CCL) by the POC due date.
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Based on observation, interviews, and records reviewed, the Licensee did not ensure there was RCFE liability insurance for the facility. This poses an immediate health, safety, and personal rights risk to persons in care.
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Type A
02/25/2026
Section Cited
HSC1569.695(f)(1)

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An evacuation chair at each stairwell, on or before July 1, 2019.
This requirement is not being met as evidenced by;
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Licensee agrees to have an evacuation chair mounted at the top of the staircase by the POC due date. Licensee to forward proof of correction to LPA by POC due date.
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LPA observed there is no evacuation chair next to the stairway. This poses an immediate health and safety risk to residents, staff and visitors.
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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.
Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:
Joseph Alejandre
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST 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


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HILLS OF ORCHID, THE
FACILITY NUMBER: 306006368
VISIT DATE: 02/24/2026
NARRATIVE
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LPA and staff toured the garage. The garage is kept locked and used for storage. Staff reported that residents do no go into the garage. No obstacles or hazards observed inside or outside of the facility. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations and Health and Safety Code. A Civil Penalty of $250 is being assessed for Failure to Correct/Repeat Violation. An exit interview was conducted and a copy of this report was given to the facility along with a copy of the, LIC 421-FC, LIC 809-D and Appeal Rights.
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Joseph Alejandre
LICENSING PROGRAM ANALYST 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
LIC809 (FAS) - (06/04)
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