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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006352
Report Date: 09/02/2026
Date Signed: 09/02/2026 05:53:32 PM

Unfounded


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
08/28/2026 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260828163555
FACILITY NAME:HILLS OF HAYWARD, THEFACILITY NUMBER:
306006352
ADMINISTRATOR:NEPOMUCENO, MARICELFACILITY TYPE:
740
ADDRESS:835 S HAYWARD STREETTELEPHONE:
(714) 827-1016
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 1DATE:
09/02/2026
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Cheenie Tagal
Allan Median Via Telephone		TIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Facility failed to provide nutritious meals.
Facility food is often spoiled.
INVESTIGATION FINDINGS:
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Regarding the allegation: Facility failed to provide nutritious meals.

During the investigation there was no corroborating information or evidence provided to support the complaint allegation. All staff and a witness denied the allegation. During the investigation it was discovered, staff make whatever the resident request to eat, when the resident requests it. Staff 2 (S2) explained the resident will not eat cold food, so the staff member will cook R1’s food upon request. LPA Haley was provided a photo of one of the meals prepared for R1 that included steak, broccoli, and corn. Multiple staff and a witness stated when the R1 request something specific, staff will get that item. During the complaint visit, LPA observed R1 come out of their room and demand a burger from In & Out. S2 who was present contacted S1 and attempted to get the burger from In & Out that R1 demanded.

Regarding the allegation: Facility food is often spoiled.
Continued on LIC9099C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20260828163555
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: 09/02/2026
NARRATIVE
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During the investigation there was no information or evidence provided to support the complaint allegation.
According to S3, R1 will often claim the food is spoiled or the staff are trying to poison the resident. S3 explained to try to prove there is nothing wrong with the food being served, staff will eat the same food as R1. During the visit, LPA Haley observed the food in the facility was of good quality and was not expired. LPA also observed S2 prepare R1 barbecue chicken and a salad for lunch upon request. The food was of good quality and R1 did not have any complaints.

Based on the information gathered during through interviews, and observation the allegations are deemed Unfounded, meaning the allegations are false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided to staff.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2