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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006352
Report Date: 01/28/2026
Date Signed: 01/28/2026 11:59:13 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
01/26/2026 and conducted by Evaluator RoseMarie Ruppert
COMPLAINT CONTROL NUMBER: 22-AS-20260126153807
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: 5DATE:
01/28/2026
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Eli Cuyson, Administrator via phoneTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff did not complete required training
Resident records are incomplete
Administrator not present at the facility a sufficient number of hours
Facility is in financial distress
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry by staff at 8am. LPA spoke with Administrator, Eli Cuyson, via phone and explained the purpose of the visit. The facility has a census of five residents in care and conducted a health and safety check for all residents in care.

LPA reviewed and obtained copies of four of four staff records. Four of four staff had the following: Personnel Record (LIC 501), Health Screening Report with Tuberculosis readings (LIC 503), Criminal Record Statement (LIC 508), current First Aid and Cardiopulmonary Resuscitation (CPR) training and are fingerprint cleared through the Department. Staff training records were reviewed and the last documented monthly in-service was conducted on January 24, 2025. Thus the allegation that staff did not complete required training is Substantiated.

(Continued on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
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 5
Control Number 22-AS-20260126153807
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: 01/28/2026
NARRATIVE
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(Continued from LIC 9099)
LPA reviewed five of five resident records. Two of five residents, Residents #2 and #3, did not have medical assessments on file and one resident, Resident #1, has not had a medical assessment since October 22, 2024. Resident #1 has a diagnosis of Senile Degeneration of the Brain, Dementia. Staff #1 contacted Administrator (AD) who also stated the paperwork could be with hospice. Thus, three of five resident records had old or missing medical assessments. The allegation that Resident records are incomplete is Substantiated.

LPA interviewed three of three staff members and the Administrator (AD) regarding the number of hours the AD is present at the facility. Three of three staff members could not confirm that the AD was present for, at the minimum twenty hours, required weekly at the facility. LPA spoke with the AD who, at the present, oversees multiple facilities and was told an Administrator would be assigned to this location. The Personnel Record (LIC 500) was not updated. Thus the allegation that Administrator not present at the facility a sufficient number of hours is Substantiated.

At time of entry, at 8am, facility did not have cable/internet services. LPA spoke with AD and CEO regarding this and, because of the change of management, there have been transition issues with accessing utilities. LIcensee is assisting in transitioning utility account information and access to the new management, Lotus Senior Housing and are working to pay any outstanding bills that were not paid. LPA toured the facility and observed the phone was working, power was on, there was water and gas and heater was operational. Cable/ internet was operational at 9:15am. LPA spoke with five of five residents and all stated they were doing fine and there were no issues. Residents and family members have received notice of the management change and a Change of Ownership is currently in process. Thus, the allegation that the Facility is in financial distress is Substantiated at this time.

Based on LPA interviews, record review and observations, the preponderance of evidence standard has been met. Therefore the above allegations: Staff did not complete required training, Resident records are incomplete, Administrator not present at the facility a sufficient number of hours and the Facility is in financial distress are Substantiated. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Eli Cuyson, Administrator (AD) via phone with Staff #1 (S1) designated to sign the reports and a copy of this report was given to the facility along with a copy of the LIC 9099-D, LIC 858, LIC 859 and Appeal Rights.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20260126153807
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: 01/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/29/2026
Section Cited
CCR
82713
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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. This requirement is not met as evidenced by: Based on LPA observation
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The Chief Executive Officer (CEO) of Lotus Senior Housing was contacted and the cable/Internet was turned on at 9:15am. CEO stated that the new management is transitioning utilities from all the Hills facilities and are working to have all bills paid and current. AD will email LPA updated payments
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and staff interviews, the cable/internet bill was not paid and was shut-off for two days. This poses an immediate health and safety risk for the five of five residents in care.
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for facility by end of business January 29, 2026.
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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: 01/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20260126153807
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: 01/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2026
Section Cited
CCR
87412(c)
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87412 Personnel Records ( c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement was not met as evidenced by: Based on LPA review of four of four personnel records and in-service training, staff training


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Administrator (AD) will provide monthly in-services for staff and will document training and send to LPA by POC due date.
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was not documented since January 24, 2025. This poses a potential risk for residents in care.
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Type B
02/27/2026
Section Cited
CCR
87458(a)
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87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record.
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AD will obtain Medical Assessments for two of five residents. AD will email LPA the two Medical Assessments by POC due date.
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This requirement was not met as evidenced by: Based on LPA review of five of five resident records, two of five residents did not have a medical assessment on file.
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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: 01/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20260126153807
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: 01/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2026
Section Cited
CCR
87405(a)
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87405 Administrator - Qualifications and Duties (a) ll facilities shall have a qualified and currently certified administrator... The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management
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A designated Administrator (AD) shall be assigned to the facility that can provide the sufficient number of hours to manage operations. Licensee to submit paperwork for AD or Administrator Designee by POC date to LPA.
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and administration of the facility...This requirement is not met as evidenced by: Based on LPA interviews, AD is not at facility for a sufficient number of hours. This poses a potential risk for residents health and safety 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: 01/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5