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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006565
Report Date: 03/20/2026
Date Signed: 03/20/2026 12:42:34 PM

Document Has Been Signed on 03/20/2026 12:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 SIERRA MAJORCA, THEFACILITY NUMBER:
306006565
ADMINISTRATOR/
DIRECTOR:		LADIA, BHONALYNFACILITY TYPE:
740
ADDRESS:19105 SIERRA MAJORCATELEPHONE:
(949) 316-4654
CITY:IRVINESTATE: CAZIP CODE:
92603
CAPACITY: 6CENSUS: 5DATE:
03/20/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:36 AM
MET WITH:Eleazar CuysonTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
NARRATIVE
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On March 20, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Eleazar Cuyson was notified via telephone and provided verbal consent that caregiver can sign on his behalf.

On today's visit, LPA observed that facility currently has a census of five residents. LPA observed residents watching television in the living room. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the five resident bedrooms (one shared bedroom and four private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 105.9 and 113.3 degrees Fahrenheit.

LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner convection stove to be operational. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit.

Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Garlli Tat
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 SIERRA MAJORCA, THE
FACILITY NUMBER: 306006565
VISIT DATE: 03/20/2026
NARRATIVE
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LPA additionally conducted interviews with two staff and two residents. One out of the two staff interviewed stated that they were paid on March 13, 2026, and they are not owed a remaining balance on their paychecks. One out of two staff reported they were not paid on March 13, 2026 and was only paid a partial amount on February 22, 2026. LPA observed that there remains an outstanding annual fee in the amount of $742.00. LPA reminded staff that the amount was due in February 14, 2026, and advised them to inform management to make a payment as soon as possible. Financial records have been received as of March 6, 2026.

Based on this inspection, deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. See LIC809-D for deficiencies. Additionally, civil penalties will be assessed on today's visit for failure to correct and repeat violation at the amount of $500.

This report was reviewed with authorized representative and a copy of this LIC809, LIC809-D, and LIC421FC report was provided and left at facility. Appeal Rights were reviewed, and a copy provided at the facility.

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Garlli Tat
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/20/2026 12:42 PM - It Cannot Be Edited


Created By: Garlli Tat On 03/20/2026 at 12:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HILLS OF SIERRA MAJORCA, THE
FACILITY NUMBER: 306006565

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/21/2026
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, .. and that assures sufficient resources to meet operating costs for care of residents..
This requirement is not evidenced by:
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The Administrator/Licensee to submit a financial plan to ensure that staff receive their pay on time. The financial plan shall be submitted via email or fax by POC date.
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Based on interviews conducted, the Licensee did not have an adequate financial plan in place to ensure staff are paid on time. This poses a potential health and safety risk to persons in care.
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Type B
03/31/2026
Section Cited
CCR87156(a)

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87156 Licensing Fees: (a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185.

This requirement was not evidenced by:
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The Licensee stated that he will pay the facility's annual fees. The Licensee agreed to provide LPA proof of payment via email or fax by POC date.
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Based on observation and records reviewed, the Licensee did not pay the facility's annual fees for 2026. This poses a potential health, safety, and personal rights risk to persons 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.
Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:
Garlli Tat
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2026


LIC809 (FAS) - (06/04)
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