306006352-9-15-2026-22-AS-AORZ-DYELAZ-20260930083557

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006352
Report Date: 09/15/2026
Date Signed: 09/15/2026 10:50:14 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
07/13/2026 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20260713164745

FACILITY NAME:	HILLS OF HAYWARD, THE		FACILITY NUMBER:	306006352
ADMINISTRATOR:	MAR JASON DASCO		FACILITY TYPE:	740
ADDRESS:	835 S HAYWARD STREET		TELEPHONE:	(714) 827-1016
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	6	CENSUS: 2	DATE:	09/15/2026
		UNANNOUNCED	TIME BEGAN:	08:51 AM
MET WITH:	Spoke with Allen Medina, Licensee via phone		TIME COMPLETED:	09:20 AM

ALLEGATION(S):

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Facility did not have electricity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced subsequent visit regarding a complaint received in the Regional Office. LPA was greeted and granted entry by Staff at 8am and LPA Jerome Haley was present conducting a separate complaint investigation.

It was alleged the facility did not have electricity. On July 9, 2026 it was reported to the Department that electricity was off for approximately two hours. Per conversation with Licensee (LE) Maricel Nepomuceno on July 16, 2026 and a follow-up email on July 17, 2026; utilities documentation was requested from the Licensees, as well as bank statement information. As of this date the Licensees failed to produce documentation that the utility bill was paid timely.

LPA interviewed two of two staff members who confirmed the electricity was off for approximately two hours. Staff contacted the Licensees regarding the utilities and the power became operational. Additionally, LPA interviewed two of two witnesses who confirmed the electricity was not operational.
(Continued on LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20260713164745

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 HAYWARD, THE	FACILITY NUMBER: 306006352
	VISIT DATE: 09/15/2026

NARRATIVE

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(Continued from LIC 9099)

There were currently two residents who resided at the facility, on July 9, 2026, but at time of the Department's visit on July 16, 2026, the two residents had since relocated.

Based on staff and witness interviews and observations, the preponderance of the evidence has been met and the allegation that Facility did not have electricity is Substantiated. An exit interview was conducted with Licensee, Allen Medina, and a copy of this report and Appeal Rights were provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026

LIC9099 (FAS) - (06/04)

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