<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006571
Report Date: 02/04/2026
Date Signed: 02/04/2026 06:30:30 PM

Document Has Been Signed on 02/04/2026 06:30 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 HIGHLAND, THEFACILITY NUMBER:
306006571
ADMINISTRATOR/
DIRECTOR:		BHONALYN LADIAFACILITY TYPE:
740
ADDRESS:11541 HIGHLAND LANETELEPHONE:
(657) 660-5308
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 3DATE:
02/04/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Administrator Eleazar CuysonTIME VISIT/
INSPECTION COMPLETED:
06:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On February 4, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility in conjunction with the complaint visit for complaint control 22-AS-20260126155937. Administrator (AD) Eleazar Cuyson was notified via telephone and later arrived to assist with the inspection.

On today's visit, the facility has a census of three residents, however, there was only one resident physically present during the visit. LPA observed two care giving staff present. LPA observed the resident to be in clean clothes. LPA, accompanied by a caregiver staff, conducted a tour of the physical plant. LPA inspected the five 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 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 three bathrooms located in the facility, two of which are dedicated for resident use. LPA observed bathrooms to be clean. Bathrooms were equipped with grab bars and non-skid floor mats.

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 six burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the kitchen pantry. LPA observed the remaining utilities, such as the electricity, gas, and internet, to be operational during the visit. LPA additionally conducted interviews with three staff and the one resident present 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)
Page: 1 of 6
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)
Page: 2 of 6
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 HIGHLAND, THE
FACILITY NUMBER: 306006571
VISIT DATE: 02/04/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
At time of LPA's arrival, at 12:45 PM, the facility was experiencing a water shut off. Licensee Allen Medina and Maricel Nepomuceno were made aware of the situation via telephone. Licensee Allen Medina and Maricel Nepomuceno stated that the water had been shut off due to the facility having an outstanding balance with their water bill. Care giving staff on duty informed LPA that water was shut off at approximately 12:45 PM. Licensee Allen Medina and Maricel Nepomuceno were unable to restore the water during the visit. As a result, the resident, with their consent and the consent of their Responsible Party, was temporarily relocated to a different licensed facility, due to the water being shut off.

LPA reviewed the files for the three residents of the facility. LPA observed that the Admission Agreement on file for Resident #1 (R1) was not signed by a facility representative. LPA observed that there was no Pre-Admission Appraisal on file for R1. LPA observed that there was no Reappraisal on file for R1 and the Reappraisal on file for Resident #2 (R2) was outdated. LPA also observed that there were no functional capability assessments on file for the three residents in of the facility. LPA additionally observed that one care giving staff present during the visit, Staff #4 (S4) was not background cleared.

Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D pages. Civil penalties will also be assessed during today's visit. An exit interview was conducted with Administrator Eleazar 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 6
Document Has Been Signed on 02/04/2026 06:30 PM - It Cannot Be Edited


Created By: Brandon Lopez On 02/04/2026 at 02:58 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 HIGHLAND, THE
FACILITY NUMBER: 306006571

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)

1
2
3
4
5
6
7
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:
1
2
3
4
5
6
7
The Administrator stated that he 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.
8
9
10
11
12
13
14
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.
8
9
10
11
12
13
14
Type B
02/20/2026
Section Cited
CCR87463(a)

1
2
3
4
5
6
7
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:
1
2
3
4
5
6
7
The Administrator stated that he will complete Reappraisals for R1 and R2. The Administrator agreed to provide LPA the Reappraisals for R1 and R2 via email or fax by POC date.
8
9
10
11
12
13
14
Based on records reviewed, the Licensee did not ensure there was a Reappraisal on file for Resident #1 (R1) and that the Reappraisal for Resident #2 (R2) was updated as frequently as necessary. This poses a potential health, safety, & personal rights risk.
8
9
10
11
12
13
14
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)
Page: 4 of 6
Document Has Been Signed on 02/04/2026 06:30 PM - It Cannot Be Edited


Created By: Brandon Lopez On 02/04/2026 at 02:59 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 HIGHLAND, THE
FACILITY NUMBER: 306006571

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)

1
2
3
4
5
6
7
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:
1
2
3
4
5
6
7
The Administrator stated that he will complete functional capability assessments for all three residents. The Administrator agreed to provide the functional capability assessments for all three residents via email or fax by POC date.
8
9
10
11
12
13
14
Based on observations and records reviewed, the Licensee did not ensure that there were functional capability assessments on file for the three residents of the facility. This poses a potential health, safety, and personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
02/20/2026
Section Cited
CCR87507(c)

1
2
3
4
5
6
7
87507 Admission Agreements: (c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, if any, and the licensee or the licensee’s designated representative..
This requirement was not evidenced by:
1
2
3
4
5
6
7
The Administrator stated that he will sign R1's Admission Agreement. The Administrator agreed to provide the signed copy of R1's Admission Agreement via email or fax by POC date.
8
9
10
11
12
13
14
Based on observation and record review, the Licensee did not ensure that Resident #1 (R1) Admission Agreement was signed by a facility representative. This poses a potential health, safety, and personal rights risk to persons in care.
8
9
10
11
12
13
14
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)
Page: 5 of 6
Document Has Been Signed on 02/04/2026 06:30 PM - It Cannot Be Edited


Created By: Brandon Lopez On 02/04/2026 at 03:12 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 HIGHLAND, THE
FACILITY NUMBER: 306006571

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/05/2026
Section Cited
CCR
87303(e)(2)

1
2
3
4
5
6
7
87303 Maintenance and Operation: (e) Water supplies ..shall be maintained as follows: (2) Faucets .. shall deliver hot water. Hot water .. shall be maintained .. not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).
This requirement was not evidenced by:
1
2
3
4
5
6
7
The Licensee agreed to paid the outstanding balance for the facility's water bill to restore the water. The Licensee agreed to provide LPA proof of payment via email or fax by POC date.
8
9
10
11
12
13
14
Based on observation, the Licensee did not ensure the facility had water as the facility was experiencing a water shutoff upon LPA's arrival. The facility remained without water for the duration of the visit. This poses and immediate health, safety, and personal rights risk to persons in care.
8
9
10
11
12
13
14
Type A
02/05/2026
Section Cited
CCR87355(e)(2)

1
2
3
4
5
6
7
87303 Criminal Record Clearance: (e) All individuals subject to a criminal record review ..shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or
This requirement was not evidenced by:
1
2
3
4
5
6
7
The Administrator stated that he will contact Guardian regarding S4's status. The Administrator stated that he will provide LPA a written plan once Guardian is contacted to ensure S4 has a criminal record clearance. The Administrator will provide the written plan to LPA via email or fax by POC date.
8
9
10
11
12
13
14
Based on observation and record review, the Licensee did not ensure all staff had a criminal record clearance as one care giving staff present during the visit, Staff #4 (S4) was not background cleared. This poses an immediate health, safety, and personal rights risk to persons in care.
8
9
10
11
12
13
14
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)
Page: 6 of 6