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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006352
Report Date: 09/16/2025
Date Signed: 09/16/2025 11:06:14 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
09/11/2025 and conducted by Evaluator RoseMarie Ruppert
COMPLAINT CONTROL NUMBER: 22-AS-20250911082349
FACILITY NAME:HILLS OF HAYWARD, THEFACILITY NUMBER:
306006352
ADMINISTRATOR:MAR JASON DASCOFACILITY TYPE:
740
ADDRESS:835 S HAYWARD STREETTELEPHONE:
(714) 827-1016
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 4DATE:
09/16/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Adora Capa, StaffTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility is in financial distress
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit for a complaint received in the Regional Office. LPA spoke with Administrator (AD) Eli Cuyson via telephone regarding the purpose of the visit and AD gave permission for staff member, Adora Capa, to sign the licensing reports.

It is alleged that the facility is in financial distress. LPA conducted a health and safety visit with the four residents in care. Three of four residents were sleeping at time of visit at 9:45am. LPA interviewed one of four residents, Resident #1 (R1) who had just eaten breakfast and stated R1 had no issues regarding food or care. LPA also interviewed two of two staff members who stated payroll has been paid and utilities were working. LPA toured the facility and observed food items in the refrigerator and cupboards. Freezers had plenty of food for the facility.

LPA obtained a copy of the staff and resident rosters and September staff schedule. AD Eli Cuyson spoke with Licensee (LE) Maricel Nepumuceno who would email monthly bills and rent paperwork to LPA.
(Continued on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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-20250911082349
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: 09/16/2025
NARRATIVE
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(Continued from LIC 9099)

LPA obtained documentation that rental payment was not received in a timely manner and funds were not available for payment on the due date of September 5, 2025. Based on record review and email communications, payment was submitted on September 5, 2025 by Licensee but it did not post or show pending status. Witness interview stated that the funds were not available on the due date and that Licensee, Allen Medina, confirmed this in email communication that the payment bounced back. The rent payment had to be re-submitted on September 11, 2025 and was received on September 12, 2025.

Based on LPA record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation that the facility is in financial distress is Substantiated. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with AD Eli Cuyson and Adora Capa, Staff member and a copy of this report was given to the facility along with a copy of the LIC 811, LIC 9099-D and Appeal Rights.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250911082349
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/03/2025
Section Cited
CCR
87213
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87213 Finances. The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such
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ADCuyson and LEs Nepomuceno and Medina spoke with LPA on a three way call regarding POC plan and date. AD and LEs will provide inservice to office staff regarding financial record documentation and payment procedures. AD and LEs will email LPA ACH information by POC due date
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financial reports as may be required upon the written request of the licensing agency. This requirement is not met as evidenced by: Based on LPA document review, rent payment did not have funds available and bounced back. This poses a potential health and safety risk to residents 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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3