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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006571
Report Date: 02/05/2026
Date Signed: 02/05/2026 03:23:52 PM

Document Has Been Signed on 02/05/2026 03:23 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:
02/05/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Licensee Allen MedinaTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On February 5, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA is following up on the visit that was conducted yesterday, please see LIC809 report dated February 4, 2026. In additional, the visit is being conducted in conjunction with the complaint visit for complaint control 22-AS-20260126155937. LPA was greeted and granted entry into the facility by Licensee (LI) Allen Medina after explaining the purpose for the visit.

On today's visit, the facility has a census of three residents, however, no residents were physically present during the visit. LPA, accompanied by the LI, 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 five bathrooms located in the facility, three of which are dedicated for resident use. LPA observed bathrooms to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. The water in each bathroom was operational and hot water measured between 116 and 119.8 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 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 all of the facility's utilities, such as the electricity, gas, water, and internet, to be operational during the visit. CONTINUED ON LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2026
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 5
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 HIGHLAND, THE
FACILITY NUMBER: 306006571
VISIT DATE: 02/05/2026
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During the complaint visit, LPA reviewed the medication administration records for January and February 2026 for the three residents of the facility. LPA observed that the medication administration record for R1 was incomplete for both January and February 2026. LPA also observed the medication administration record for R2 was incomplete for January 2026. LPA observed that facility staff failed to initial the medication administration records for R1 and R2, indicating that the medications were dispensed according to their prescribed orders.

During the complaint visit, LPA was also informed that R2 was abruptly removed from the facility on January 29, 2026. The two staff present when R2 was removed from the facility stated that they believe she was taken by family. However, the two staff stated that they were unable to confirm the identity of who exactly removed R2. In additional, the staff stated that they did not have the family sign in on the facility's visitation log, despite signing in being a facility policy.

In addition, California Code of Regulation Title 22 Section 87205 Accountability of Licensee Governing Body states: (a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. Based on the recent visits conducted to the facility, it does not appear that the licensee has provided sufficient supervision as the facility is in disrepair, the facility in financial distress, resident records are incomplete, staff training has not been completed, and the facility does not have an Administrator present a sufficient amount of hours.

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 Licensee Allen Medina. 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: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/05/2026 03:23 PM - It Cannot Be Edited


Created By: Brandon Lopez On 02/05/2026 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: 02/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2026
Section Cited
CCR
87208(a)

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87208 Plan of Operation: (a)The licensee shall have and maintain a current, written definitive plan of operation for the facility. .. and may be cited for not doing so ...
This requirement was not evidenced by:
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The Licensee stated that he will conduct an in service training with staff regarding the vistor log policy. The Licensee agreed to provide LPA proof of training via email or fax by POC date.
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Based on interviews conducted, the Licensee did not ensure staff followed the facility's plan of operation since staff did not ensure visistors signed into the vistor log. 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: 02/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/05/2026 03:23 PM - It Cannot Be Edited


Created By: Brandon Lopez On 02/05/2026 at 03:03 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: 02/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/06/2026
Section Cited
CCR
87465(a)(4)

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87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility..(4) The licensee shall assist residents with self-administered medications as needed.
This requirement was not evidenced by:
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The Licensee stated that he will conduct an in service training with staff regarding the proper documentation of resident's medication administration records. The Licensee agreed to provide LPA proof of the training via email or fax by POC date.
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Based on observations and records reviewed, the Licensee did not ensure the medication administration records for two residents were completely accurately. This poses an immediate health, safety, and personal rights risk to persons in care.
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Type A
02/06/2026
Section Cited
CCR87205(a)

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87205 Accountability of Licensee Governing Body: (a) The licensee.. shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations...
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The Licensee stated that he will complete a statement understanding the regulaion and will commit to provide enough supervision over the facility. The Licensee agreed to provide the statement to LPA via email or fax by POC date.
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Based on observations, interviews, and records reviewed, the Licensee has not provided sufficient supervision as the facility is in disrepair, in financial distress, and does not have an Administrator present a sufficient amount of hours. This poses an immediate 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: 02/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2026


LIC809 (FAS) - (06/04)
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