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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435201105
Report Date: 03/04/2026
Date Signed: 03/04/2026 04:36:22 PM

Document Has Been Signed on 03/04/2026 04:36 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:HILLSDALE HOMEFACILITY NUMBER:
435201105
ADMINISTRATOR/
DIRECTOR:		JOHN TANAKAFACILITY TYPE:
735
ADDRESS:318 LOS PINOS WAYTELEPHONE:
(408) 599-9595
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY: 6CENSUS: 3DATE:
03/04/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Rhonald AranzasoTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Steve Chang and Licensing Program Manager (LPM) Christine Kabariti conducted an unannounced case management visit regarding the change of licensee of the facility. LPA and LPM met with the current licensee Rhonald Aranzaso (SA) and Administrator Maria Sheila Francisco (MSF).

On 03/03/2026, the Department was informed of a change of ownership from the previous licensee/sole proprietor, John Tanaka (JT) to a new licensee, Rhonald Aranzaso (RA) of as 11/17/2025. The Department did not receive a formal notice of the change of ownership nor did the Department receive an application from SA of the change of ownership.

LPA and LPM interviewed SA. SA stated the previous licensee (JT) retired on 11/17/2025 and SA took over the facility license on 11/17/2025. SA stated that he is currently operating under a LLC. SA stated the previous licensee (JT) terminated his lease agreement and SA took over the new lease agreement at the facility property starting 12/31/2025.

SA stated to have sent a letter of content to take over the facility to the Department and San Andreas Regional Center (SARC) in September 2025. SA stated that JT was supposed to inform the Department of the change of ownership but was unable to provide proof of that notification. Based on record review, JT verbally informed the Department in August 2025 regarding his plans to retire, however, did not formally follow-up with the Department after August 2025 when he sold the facility to SA.

During today's visit, SA signed up for component I orientation and showed proof of receipt. SA stated a plan to submit a new application for the change of ownership, to the Centralized Applications Bureau (CAB) today, 3/4/2026. See LIC809-C.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Chihhsien Chang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2026
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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Document Has Been Signed on 03/04/2026 04:36 PM - It Cannot Be Edited


Created By: Chihhsien Chang On 03/04/2026 at 10:44 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
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: HILLSDALE HOME
FACILITY NUMBER: 435201105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/11/2026
Section Cited
CCR
80061(a)

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80061 Reporting Requirements (a) Each licensee or applicant shall furnish to the licensing agency reports as required by the Department, including, but not limited to, those specified in this section.

This requirement is not met as evidenced by:
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The facility did not notify the Department that the facility change licensee on 11/17/2025.
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Based on interview and record review, the facility did not notify the Department that the facility change licensee on 11/17/2025. This poses an potential health, safety risk to persons in care.
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Type B
03/11/2026
Section Cited
CCR80063(a)

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80063 Accountability (a) The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation.

This requirement is not met as evidenced by:
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Licensee stated to read the title 22 section and submit a plan of correction by the POC due date.
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Based on interview and record reviewed, the facility did not notify the Department that the facility has licensee change and the current licensee, John Tanaka did not provide the general supervision and responsibility to the facility residents while undergoing a change of ownership, which 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.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Chihhsien Chang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2026


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 03/04/2026 04:36 PM - It Cannot Be Edited


Created By: Chihhsien Chang On 03/04/2026 at 10:53 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
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: HILLSDALE HOME
FACILITY NUMBER: 435201105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/11/2026
Section Cited
CCR
80034(2)

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80034 Submission of New Application (a) A licensee shall file a new application as required by Section 80018 whenever there is a change in conditions or... other changes including but not limited to the following:(2) Any change of licensee, including but not limited to the following when the licensee is a corporation.
This requirement is not met as evidenced by:
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Licensee stated the facility will apply for new application on 3/4/2026, and submit the plan of correction by the POC due date.
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Based on interview and record reviewed, the facility did not submit a new application after the facility licensee change.
This poses an potential health, 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.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Chihhsien Chang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2026


LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: HILLSDALE HOME
FACILITY NUMBER: 435201105
VISIT DATE: 03/04/2026
NARRATIVE
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SA stated a plan to contact the landlord and previous licensee (JT), to make an addendum to the current lease agreement to include JT. SA states the addendum to the lease agreement will be completed by Friday 3/6/2026. SA was informed that because the current license is under JT, JT is still accountable for the facility while SA is undergoing licensure for change of ownership.

During visit, LPA and LPM toured the facility to include the kitchen, dining room, garage, 4 bedrooms, living room, and bathroom. There was 1 resident present who was sick and did not attend day program to 1 staff member. The staff was fingerprint cleared and associated to the facility. SA informed LPA and LPM of undergoing renovations in December 2025 that was completed before 12/31/2025. Renovations that were completed that LPA and LPM observed includes all new flooring from carpet to hardwood floors, fresh interior paint on the walls and ceiling, and fixed wall and flooring due to a leak in the corner of the family room area. SA and MSF was informed to notify the Department of any construction or alterations to the facility per Title 22 Section 80086 - Alterations to Existing Building or New Facilities. A technical violation was provided.

Deficiencies noted today per California Code of Regulations. See LIC809-D. Exit interview was conducted with SA. The report was provided to SA for review. A copy of the report and appeal rights was provided to SA.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Chihhsien Chang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC809 (FAS) - (06/04)
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