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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006492
Report Date: 02/04/2026
Date Signed: 02/04/2026 11:41:42 AM

Document Has Been Signed on 02/04/2026 11:41 AM - 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 MALLORCA, THEFACILITY NUMBER:
306006492
ADMINISTRATOR/
DIRECTOR:		CUYSON, ELEAZARFACILITY TYPE:
740
ADDRESS:27041 MALLORCA LANETELEPHONE:
(714) 430-7672
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 4DATE:
02/04/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator Janine CuysonTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On February 4, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with the inspection.

On today's visit, LPA observed four residents in care and two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied by a caregiver staff, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed that Resident #4 (R4) had full bed rails on her bed, however, R4 is currently not receiving hospice services. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two shared resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. The water in each of the resident bathrooms was operational and measured between 109.4 to 111.9 degrees Fahrenheit.

LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and four residents during the visit. Three out of the three staff interviewed confirmed that they are up to date on their salary and have been paid on time.

CONTINUED ON LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2026
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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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 MALLORCA, THE
FACILITY NUMBER: 306006492
VISIT DATE: 02/04/2026
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LPA reviewed the files for the four residents in care. LPA observed that there was no Pre-Admission Appraisal on file for Resident #1 (R1). LPA observed that there was no Reappraisal on file for R1. LPA observed that the Reappraisals on file for Resident #2 (R2) and Resident #3 (R3) were outdated. LPA also observed that there were no functional capability assessments on file for the four residents in care. All staff present during the visit were background cleared and associated to the facility.

Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D pages. An exit interview was conducted with Administrator Janine Cuyson. A copy of the report and Appeal Rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/04/2026 11:41 AM - It Cannot Be Edited


Created By: Brandon Lopez On 02/04/2026 at 11:10 AM
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 MALLORCA, THE
FACILITY NUMBER: 306006492

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2026
Section Cited
CCR
87457(c)

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87457 Pre-Admission Appraisal: (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs...
This requirement was not evidenced by:
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The Administrator stated that she will complete a Pre-Admission Appraisal for R1. The Adminstrator agreed to provide LPA the Pre-Admission Appraisal for R1 via email or fax by POC date.
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Based on observations and records reviewed, the Licensee did not ensure there was a Pre-Admission Appraisal on file for Resident #1 (R1). This poses a potential health, safety, and personal rights risk to persons in care.
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Type B
02/20/2026
Section Cited
CCR87463(a)

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87463 Reappraisals: (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first...
This requirement was not evidenced by:
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The Administrator stated that she will complete Reappraisals for R1, R2. and R3. The Administrator agreed to provide LPA the Reappraisals for R1, R2, and R3, via email or fax by POC date.
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Based on records reviewed, the Licensee did not ensure there was a Reappraisal on file for Resident #1 (R1) and that the Reappraisals for Resident #2 (R2) and Resident #3 (R3) were updated as frequently as necessary. This poses a potential health, safety, & personal rights risk.
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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:
Brandon Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/04/2026 11:41 AM - It Cannot Be Edited


Created By: Brandon Lopez On 02/04/2026 at 11:19 AM
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 MALLORCA, THE
FACILITY NUMBER: 306006492

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2026
Section Cited
CCR
87459(a)

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87459 Functional Capabilities: (a) The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living. Such activities shall include, but not be limited to.. This requirement was not evidenced by:
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The Administrator stated that she will complete functional capability assessments for all four residents. The Administrator agreed to provide the functional capability assessments for all four residents via email or fax by POC date.
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Based on observations and records reviewed, the Licensee did not ensure that there were functional capability assessments on file for the four residents in care. This poses a potential health, safety, and personal rights risk to persons in care.
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Type B
02/20/2026
Section Cited
CCR87608(a)(5)(B)

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87608 Postural Supports (a) ... Postural supports may be used ..(5) Under no circumstances shall postural supports include..(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care.
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The Administrator stated that the facility will not use the full bed rails for R4. The Administrator stated that they will get an order for half bed rails for R4. The Administrator agreed to provide the half bed rail order for R4 to LPA via email or fax by POC date.
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This requirement was not evidenced by: LPA observed that Resident #4 (R4) had full bed rails, however, R4 is currently not receiving hospice services and did not have an order on file for any bed rails. 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.
Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:
Brandon Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2026


LIC809 (FAS) - (06/04)
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