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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006118
Report Date: 06/15/2026
Date Signed: 06/15/2026 11:18:14 AM

Document Has Been Signed on 06/15/2026 11:18 AM - 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 SHAY DEL, THEFACILITY NUMBER:
306006118
ADMINISTRATOR/
DIRECTOR:		NEPOMUCENO, MARICELFACILITY TYPE:
740
ADDRESS:5982 SHAY DEL PLACETELEPHONE:
(626) 827-9547
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 6CENSUS: 4DATE:
06/15/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Administrator Heddymae OysonTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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On June 15, 2026, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. LPA Kim met with Administrator (ADMIN) Heddymae Oyson and explained the purpose of the visit.

LPA Kim conducted a health and safety check. During the visit, LPA toured the facility and observed the following: LPA observed two staff on duty providing care to four residents. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Staff stated food gets delivered one time per week. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The hot water temperature measured at 105.6 degrees F and 106.5 degrees F. The indoor temperature measured at 77 degrees F. All smoke detectors and carbon monoxide detectors were operational. All emergency disaster supplies were prepared and available in the garage. Facility land line (714) 646-9615 was tested and remains available. No obstacles observed in the backyard. Staff #1 on LIC 500 was not cleared and not associated to the facility. Residents interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. LPA conducted interviews with three residents and two staff. LPA observed valid certificate of liability insurance effective April 2, 2026, and expires on April 2, 2027. LPA spoke with residents and resident responsible parties who stated they were provided written notices that the Department is commencing proceedings to revoke the facility's license. The notice did not state the correct contact information for the Department of Social Services Community Care Licensing Division Adult Senior Care Program Orange County Regional Office address and phone number. The notice did not state to contact the department if they were to seek the license status of the facility. LPA Kim observed the facility has a notice posted to inform all residents and residents' responsible parties about the Department is commencing proceedings to revoke the facility's license.
CONTINUED ON LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Edward Kim
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2026
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 SHAY DEL, THE
FACILITY NUMBER: 306006118
VISIT DATE: 06/15/2026
NARRATIVE
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Deficiencies were cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA observed during the visit Staff #1 (S1) was listed on the LIC500 and was present during the visit. LPA reviewed records and found that S1 did not have background clearance and association with the facility. S1 left the facility at 9:00 AM. A notice was sent out to the resident and/or resident's responsible parties did not have a statement that directs the resident or the resident’s responsible party to contact the division for information on the license status of the facility. The notice did not provide the correct information for Department of Social Services Community Care Licensing Adult Senior Care Orange County Regional Office address and office phone number. A Civil Penalty was assessed for the amount of $100 during the visit due to S1 not having criminal background clearance and not being associated with the facility.

An exit interview was conducted, and a copy of this report, LIC809D, LIC421IM, and appeal rights were provided to Administrator Heddymae Oyson..
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Edward Kim
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/15/2026 11:18 AM - It Cannot Be Edited


Created By: Edward Kim On 06/15/2026 at 10:04 AM
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 SHAY DEL, THE
FACILITY NUMBER: 306006118

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/16/2026
Section Cited
CCR
87355(e)(2)

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CRC 87355(e)(2) All individuals subject to a criminal record review... shall prior to working, residing or volunteering.,,: Obtain a California clearance or a criminal record exemption as required by the Department This requirement is not met as evidenced by:
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Licensee stated that they will provide background clearance prior to S1 returning to the facility. Licensee stated they will send a plan for S1, and all documentation and proof that S1 has background clearance and association to CCLD via email to edward.kim@dss.ca.gov by POC due date
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Based on interviews, observation, and record review, the Licensee did not ensure all staff had a criminal record clearance as one care giving staff present during the visit, Staff #1 (S1) was not background cleared. This poses an immediate health, safety, and personal rights risk to persons in care.
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June 16, 2026.

***Civil Penalty assessed.***
Type B
06/19/2026
Section Cited
HSC1569.38(c)

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HSC1569.38(c) The notice provided to a resident and the resident’s responsible party, shall include the name and contact information for the local long-term care ombudsman and Community Care Licensing Division... with a statement that directs the resident or the resident's responsible party to contact the division for information on the license status of the facility...
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Licensee stated they will send a new notice to the residents and residents' responsible parties with statement that directs contact information about license status of the facility and correct information of the department and a copy to CCLD via email to
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This requirement is not met as evidenced by:
Based on record review, the notice sent to the residents and/or residents' responsible parties the licensee did not write the statement for information on license status and the correct contact information. This poses a potential health, safety, and personal rights risk to persons in care.
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edward.kim@dss.ca.gov by POC due date June 19, 2026.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Edward Kim
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2026


LIC809 (FAS) - (06/04)
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