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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006495
Report Date: 01/20/2026
Date Signed: 01/20/2026 10:22:03 AM

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
08/22/2025 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20250822085244
FACILITY NAME:HILLS OF SANTA TERESA, THEFACILITY NUMBER:
306006495
ADMINISTRATOR:NEPOMUCENO, MARICELFACILITY TYPE:
740
ADDRESS:17698 SANTA TERESA CIRCLETELEPHONE:
(714) 430-7672
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 3DATE:
01/20/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Rian Del Leon, CaregiverTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff sleeping while on duty.
INVESTIGATION FINDINGS:
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On January 20, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a subsequent complaint investigation visit into the above allegation. LPA introduced self, stated the purpose of the visit to staff, and was granted entry into the facility. LPA spoke with Administrator (AD) Rosendo “Carla” Miranda and Licensee Allen Medina via telephone, explained the reason for the visit and was notified that Caregiver Rian DeLeon was granted permission to sign the report for today.

On August 28, 2025, LPA initiated the complaint investigation. During the visit, LPA toured the facility accompanied by AD Miranda and obtained the following documentation: Resident/Staff Rosters, Personnel Record (LIC500), Staff Schedules, Face Sheets, Physician’s Reports, and Needs & Services appraisals.


Report continued on LIC 9099-C…..
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026
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-20250822085244
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 SANTA TERESA, THE
FACILITY NUMBER: 306006495
VISIT DATE: 01/20/2026
NARRATIVE
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Regarding the allegation, Staff sleeping while on duty, it was reported that staff are not awake during the night shift. During initial visit, LPA conducted three staff interviews, five resident interviews, and reviewed records. While conducting interviews, S1 stated staff are sleeping at night when residents require care. S2 they sleep in living room and wake up to assist R1 when the bed alarm goes off. A record review revealed, R1 needs total supervision per Physician’s report and wakes up at night per appraisal. R2 has a G-Tube and continence needs, and R3 has a colostomy bag and needs assistance with care. Based on the records reviewed, staff are needed and required to remain awake during nighttime hours.

During complaint intake, it was reported by Reporting Party (RP) that day shift, Staff #1 (S1) disclosed to RP that night shift staff sleeps while on duty. Based on the interview on September 3, 2025, RP stated S1 was the person who disclosed that other staff are sleeping at night but did not disclose any names. RP also stated that they do not know who works there and could not provide any additional details regarding the allegation.

The investigation revealed that staff are sleeping while on duty when residents in care require total supervision. Based on interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC9099D.
An exit interview was conducted with Caregiver Rian DeLeon, LIC809-D, and the appeal rights were provided at the end of the visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250822085244
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 SANTA TERESA, THE
FACILITY NUMBER: 306006495
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/27/2026
Section Cited
CCR
87464(f)(1)
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87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).
This requirement was not met as evidenced by:
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The licensee will retain staff on night supervision requirements to address care needs of residents. Licensee will submit proof of training to CCLD by POC due date.
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Based on interviews and record review, the licensee did not ensure staff are providing care and supervision to prevent and address R1, R2, and R3’s care needs during night supervision, which poses a potential health and safety 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: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3