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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006492
Report Date: 05/20/2025
Date Signed: 05/20/2025 04:01:59 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
04/10/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250410141252
FACILITY NAME:HILLS OF MALLORCA, THEFACILITY NUMBER:
306006492
ADMINISTRATOR:CUYSON, ELEAZARFACILITY TYPE:
740
ADDRESS:27041 MALLORCA LANETELEPHONE:
(714) 430-7672
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
05/20/2025
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Eleazar Cuyson, administratorTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Facility is in financial distress.

Facility did not meet the reporting requirements.
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the two allegations listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Eleazar Cuyson was notified via telephone and assisted with the visit remotely. Report read to administrator who gave caregiving staff permission to sign on their behalf.

An initial investigation visit was conducted on April 14, 2025. During the visit, LPA accompanied by staff conducted a tour of the physical plant and reviewed the facility's food supply, incontinence supplies and hot water supply. Resident records for all individuals admitted at this time were also reviewed. A total of four staff interviews and one resident interview were conducted.

CONTINUED ON FORM LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
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-20250410141252
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 MALLORCA, THE
FACILITY NUMBER: 306006492
VISIT DATE: 05/20/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Facility is in financial distress, the following has been concluded: Based on staff interviews conducted and correspondence obtained during the investigation, the licensee has been unable to provide timely payments of the rent as required by the leasing agreement signed with the owner of the property in which the facility operates. As of the initial visit, past rent due extended to January 2025. On May 2, 2025, an unlawful detainer was served by the landlord to the licensee, confirming that the situation was still ongoing. Evidence therefore corroborates financial issues experienced by the licensee.

Regarding the allegation that Facility did not meet the reporting requirements, the following has been concluded: Neither the initial financial issues nor the issuance of a unlawful detainer were reported to the Department by facility staff. Reporting requirements were therefore not met.

As a result, both allegations are found to be Substantiated, meaning that the preponderance of evidence threshold has been met. Corresponding deficiencies are cited on an attached form LIC9099-D.

An exit interview was conducted with the administrator and a copy of this report along with appeal rights were provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250410141252
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 MALLORCA, THE
FACILITY NUMBER: 306006492
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2025
Section Cited
CCR
87213
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Per CCR Section 87213 on Finances: "The licensee shall have a financial plan (...) that assures sufficient resources to meet operating costs for care of residents". This requirement is not met as evidenced by: Based on records reviewed and interviews conducted,(...)
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Licensee stated a resolution was in progress involving a modification of the ownership structure. Proof of initial application to be provided to the LPA
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it has been determined that the licensee had been unable to cover operating costs related to the leased property for the period of January to April 2025. This constitutes a potential risk to the health, safety and personal rights of individuals in care.
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Type B
06/16/2025
Section Cited
CCR
87211(d)
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Per CCR 87211(d): "The licensee shall notify the Department in writing within two business days of any of the following specified events, or knowledge thereof: (...) (2) An unlawful detainer action is initiated against the licensee. (...)(4) The licensee receives a written notice of default of payment of rent.
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Licensee will provide a statement indicating that they have reviewed the reporting requirements and intend to adhere to them. Statement to be provided in writing to the Department before the plan of corrections due date.
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This requirement was not met as evidenced by: Based on interviews conducted and records reviewed, no written reports of past due rent or of an unlawful detainer were provided to the Department. This constitutes a potential risk to the health, safety and personal rights of residents 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: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3