<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006118
Report Date: 02/17/2026
Date Signed: 02/17/2026 03:18:23 PM

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
02/13/2026 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260213100418
FACILITY NAME:HILLS OF SHAY DEL, THEFACILITY NUMBER:
306006118
ADMINISTRATOR:NEPOMUCENO, MARICELFACILITY TYPE:
740
ADDRESS:5982 SHAY DEL PLACETELEPHONE:
(626) 827-9547
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:6CENSUS: 5DATE:
02/17/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Licensee Allen Medina via telephoneTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not issue responsible party proper refund.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On February 17, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to initiate the investigation into the allegation listed above and to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Licensee Allen Medina was notified via telephone but was unable to assist with today's inspection.

During the course of the investigation, LPA conducted staff interviews, reviewed and obtained pertinent documents for this complaint. Regarding the allegation, staff did not issue responsible party proper refund, the following has been concluded: It was alleged that staff did not issue responsible party proper refund for Resident #1 (R1). R1 was admitted to the facility on September 25, 2025, and passed away on October 19, 2025. LPA reviewed R1's admission agreement. LPA observed that on R1's admisson agreement, is states, "Per community policy, the admission agreement is automatically terminated on the date of the resident's death. The responsible party will not be responsible for any charges after the resident's date of death."
CONTINUED ON LIC9099-C
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026
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 3
Control Number 22-AS-20260213100418
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 SHAY DEL, THE
FACILITY NUMBER: 306006118
VISIT DATE: 02/17/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA conducted an interview with R1's responsible party, Witness #1 (W1). W1 stated that R1's rent was paid in full for the month of October 2025. W1 confirmed that R1 passed away on October 19, 2025, and the facility did not issue them a refund for the remaining twelve days of October 2025, despite multiple request. LPA conducted an interview with Licensees Allen Medina and Maricel Nepomuceno. Both Licensees interviewed admitted that a refund had not been issued to W1 after R1 passed away on October 19, 2025. LPA also observed that there was an email exchange between W1 and Licensee Maricel Nepomuceno, in which Licensee Maricel Nepomuceno admitted that a refund was not issued to W1 after R1 passed away.

Based on the evidence gathered during this investigation, the Department obtained sufficient evidence to substantiate the allegation that, staff did not issue responsible party proper refund. The preponderance of evidence standards has been met; therefore, the above allegation is SUBSTANTIATED. A deficiency is being cited on the attached LIC9099-D. An exit interview was conducted via telephone with Licensee Allen Medina. A copy of the report and Appeal Rights were provided to an authorized facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260213100418
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 SHAY DEL, THE
FACILITY NUMBER: 306006118
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/17/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2026
Section Cited
CCR
87507(f)
1
2
3
4
5
6
7
87507 Admission Agreement: (f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments.
This requirement was not evidenced by:
1
2
3
4
5
6
7
The Licensee stated that he will issue a refund to Resident #1's resposible party for the remaining twelve days of October 2025. The Licensee agreed to provide LPA proof of the refund via email or fax by POC date.
8
9
10
11
12
13
14
Based on inteviews conducted and records reviewed, the Licensee's did not issue a refund to Resident #1's responsible party after his death. This poses a potential health, safety, and personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3