306006352-9-2-2026-22-AS-KSGH-DYCVVK-20260928164626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006352
Report Date: 09/02/2026
Date Signed: 09/02/2026 05:52:45 PM

Unsubstantiated

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, THE		FACILITY NUMBER:	306006352
ADMINISTRATOR:	NEPOMUCENO, MARICEL		FACILITY TYPE:	740
ADDRESS:	835 S HAYWARD STREET		TELEPHONE:	(714) 827-1016
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	6	CENSUS: 1	DATE:	09/02/2026
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Cheenie Tagal Allan Median Via Telephone		TIME COMPLETED:	02:59 PM

ALLEGATION(S):

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Resident was physically abused by staff resulting in bruising.
Resident did not receive medications.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received August 28, 2026. LPA Haley was greeted by staff and explained the reason for the visit upon entry. The complaint investigation consisted of interviews with facility staff, two witnesses, document review, and LPA observations.

Regarding the allegation: Resident was physically abused by staff resulting in bruising.
During the investigation 5 of 5 individuals who were interviewed denied the complaint allegation and/or were unable to provide any corroborating information or evidence to support the complaint allegation. According to a staff member and a witness who was interviewed, R1 will harm themselves. According to Staff 1 (S1), R1 will hit themselves against the wall/door. Witness 1 (W1) stated R1 has a history of scratching themselves and would not be surprised if the resident banged themselves against a wall and caused bruising.

Continued on LIC9099C

Unsubstantiated

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)

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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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W1 explained that the resident has very thin skin and combined with some of the medication they take, the resident can bruise easily. During the investigation LPA Haley was provided two different videos. One video recorded on August 19, 2026, shows the aftermath of R1 damaging the inside of the facility and a care providers personal property. The person recording the video also stated the resident was hitting/harming thyself during the behavior incident. Another video recorded on August 22, 2026, actually shows R1 verbally abusive to staff and throwing an object at the staff member who moved out of the way.

Regarding the allegation: Resident did not receive medications.

During the investigation it was discovered that medications are being administered as prescribed. However, R1 has been refusing to see their physician and has refused to participate in a tel-a-visit with the physician to have some of their medications refilled and/or adjusted. Facility staff have been in contact with W1 regarding R1’s refusal of medical care. LPA Haley was provided copies of text messages between the facility and W1 regarding R1’s refusal of medical care.

Based on the information gathered through interviews, document review, and LPA observations the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there’s not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed unsubstantiated.

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)

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