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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006369
Report Date: 06/04/2026
Date Signed: 06/04/2026 12:19:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
06/01/2026 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260601091902
FACILITY NAME:HILLS OF GOWDY, THEFACILITY NUMBER:
306006369
ADMINISTRATOR:SO, BRYANTFACILITY TYPE:
740
ADDRESS:23981 GOWDY AVENUETELEPHONE:
(714) 430-7672
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 4DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Caregiver John Dennis MangilitTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility did not adequately address resident's catheter.
INVESTIGATION FINDINGS:
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On June 4, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to the facility to initiate the investigation into the allegation listed above and to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Eleazar Cuyson was notified via telephone but was unable to assist with today's inspection.

During the course of the investigation, LPA interviewed a resident, interviewed staff, reviewed and obtained pertinent documents for this complaint. Regarding the allegation, facility did not adequately address resident's catheter, the following has been concluded: It was alleged that the facility did not adequately address Resident #1 (R1's) catheter. LPA conducted a file review for R1. Per R1's medical assessment dated May 29, 2026, R1 is diagnosed with senile dementia and is unable to manage any of his treatment, medication, or medical equipment. Per R1's after visit summary from the hospital dated March 2, 2026, it states that the facility staff are responsible for cleaning the area around R1's catheter every day. CONTINUED ON LIC9099-C
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
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 3
Control Number 22-AS-20260601091902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 GOWDY, THE
FACILITY NUMBER: 306006369
VISIT DATE: 06/04/2026
NARRATIVE
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LPA conducted an interview with R1, but was unable to qualify R1 for an interview due to his current cognitive condition. LPA conducted four staff interviews. Four out of the four staff interviewed denied the allegation and stated that the area around R1's catheter has been cleaned everyday. However, based on the file review for R1, LPA observed that the facility currently does not have a care plan that addresses R1's catheter needs. LPA observed that the most recent care plan on file for R1 is dated August 3, 2023, and it does not state how the staff will be assisting R1 with his needs regarding his catheter. Per California Code of Regulation Section 87612, a catheter is categorized as a restriction health condition. Per California Code of Regulation Section 87613(a)(2), it states: (a) Prior to admission of a resident with a restricted health condition, the licensee shall: (2) Ensure that facility staff who will participate in meeting the resident’s specialized care needs complete training provided by a licensed professional sufficient to meet those needs. During the investigation, the Licensee was unable to provide any documented training that demonstrated that the facility staff were provided with specialized training from a licensed professional for R1's catheter needs. Three staff interviewed also corroborated that they did not receive any training from a licensed professional for R1's catheter needs.

Based on the evidence gathered during this investigation, the Department obtained sufficient evidence to substantiate the allegation that, facility did not adequately address resident's catheter. The preponderance of evidence standards has been met; therefore, the above allegation is SUBSTANTIATED. A deficiency is being cited on the attached LIC9099-D page. An exit interview was conducted with Administrator Eleazar Cuyson via telephone. A copy of the report and appeal rights were provided to the facility at time of visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260601091902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 GOWDY, THE
FACILITY NUMBER: 306006369
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2026
Section Cited
CCR
87613(a)
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87613 General Requirements for Restricted Health Conditions: (a) Prior to admission of a resident with a restricted health condition, the licensee shall:
This requirement is not evidenced by: Based on records reviewed and interviews conducted, the Licensee did not ensure
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The Administrator stated that he will update the care plan for R1 to address his catheter needs and will have a licensed professional train the facility staff who assist with R1's catheter needs. The Administrator agreed to provide LPA the updated care plan and proof of training via email or fax by POC due date.
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that the facility had an adequate plan to address Resident #1's (R1) catheter needs. R1's care plan does not address his catheter and staff did not receive any training for R1's catheter needs. This poses a potential health, safety, and 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: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3