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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006571
Report Date: 04/28/2026
Date Signed: 04/28/2026 03:00:27 PM

Document Has Been Signed on 04/28/2026 03:00 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: 0DATE:
04/28/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Licensees Allen Medina and Keak VongphakdyTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On April 28, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA was greeted and granted entry into the facility by Licensees Allen Medina and Keak Vongphakdy after explaining the purpose for the visit.

On today's visit, LPA observed the facility still has no residents in care and remains vacant. LPA, accompanied by the Licensees, conducted a tour of the physical plant of the facility. LPA inspected the five resident bedrooms and observed them to be free of hazards. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the five bathrooms located in the facility. LPA observed bathrooms to be clean. Bathrooms are equipped with grab bars and non-skid floor mats. LPA conducted a tour of the kitchen area. 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 inspected the three fire extinguishers located in the facility. The facility was issued a technical violation during the previous visit conducted on April 13, 2026, due to the fire extinguishers not being serviced annually. During today's visit, LPA observed that the fire extinguishers still have not been serviced and were last serviced on April 8, 2025. LPA observed all of the facilities utilities, such as the electricity, water, gas, and internet, to be operational during the visit.

LPA, accompanied by the Licensees, conducted a tour of the exterior portions of the facility. LPA observed the exterior to be free of any obstructions or hazards. LPA conducted interviews with three staff during the visit. Two out of the three staff reported that they were up to date on their wages. However, one staff stated that they have not received the remaining of their wages for the March 7, 2026, or the March 22, 2026, pay periods. CONTINUED ON LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2026
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: 04/28/2026
NARRATIVE
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LPA conducted an interview with a Licensee during the visit. The Licensee confirmed one staff has an outstanding balance for past owed wages and that the facility's rent was not paid for March or April 2026. During the previous visit conducted to the facility on April 13, 2026, LPA requested the following documents to be submitted to him by close of business day April 17, 2026, to assess the Licensees current financial situation:
  • Proof of rent payments for March and April 2026.
  • All utility bills (water, gas, electricity, trash, internet) for March 2026.
  • Payroll records for March 2026.

As of today, April 28, 2026, LPA has still not received the full extent of the records requested. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D pages. Additionally, a civil penalty will be assessed for a failure to correct. The Licensees have still not corrected a deficiency that was originally cited on March 9, 2026. A civil penalty will be assessed in the amount of $100 per day, from April 14, to April 28, 2026, for a total of $1,500.00. An exit interview was conducted with Licensees Allen Medina and Keak Vongphakdy. A copy of the report and appeal rights were provided at time of visit.
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 04/28/2026 03:00 PM - It Cannot Be Edited


Created By: Brandon Lopez On 04/28/2026 at 02:21 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: 04/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2026
Section Cited
CCR
87203

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87203 Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.
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The Licensee stated that he will service all fire extinguishers in order to comply with State Fire Marshal regulations. The Licensee agreed to provide LPA provide of fire extinguishers being serviced via email or fax by POC date.
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Based on observation, the Licensee did not ensure that all fire extinguishers at the facility were serviced annually, which violates State Fire Marshal regulations. This 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.
Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:
Brandon Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/28/2026 03:00 PM - It Cannot Be Edited


Created By: Brandon Lopez On 04/28/2026 at 02:49 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: 04/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/29/2026
Section Cited
CCR
87213

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87213 Finances: The licensee shall have a financial plan.. shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency...
This requirement was not evidenced by:
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The Licensee stated that he will provide LPA the requested documents and will submit a plan on how he will address the owed wages to staff. The Licensee agreed to provide LPA the written plan via email or fax by POC date.
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Based on observation and records reviewed, the Licensee did not provide all the requested documents to Community Care Licensing as requested. The Licensee has also not resolved previous staff wage issues. 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: 04/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2026


LIC809 (FAS) - (06/04)
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