HILLS OF SHAY DEL, THE

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 (f)(1) Basic services shall at a minimum include. Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not evidenced by: Based on observation, interview, and record review, the licensee did not comply with the section cited above. Resident #1 (R1) was handled in a rough manner on April 15, 2026, that led to bruises where their physical health, safety, or welfare were endangered. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated they will ensure all staff are trained on how to transfer residents who have dementia and send proof of completed training and copy of the training material to CCLD via email to edward.kim@dss.ca.gov by POC due date July 9, 2026.

Deadline recorded: Jul 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

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: 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.

Official plan of correction

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 June 16, 2026. ***Civil Penalty assessed.***

Deadline recorded: Jun 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.38(c)

Regulation authority

HSC

What the official deficiency says

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... 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.

Official plan of correction

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 edward.kim@dss.ca.gov by POC due date June 19, 2026.

Deadline recorded: Jun 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.38(b)(1)

Regulation authority

HSC

What the official deficiency says

1569.38 (b)(1) A licensed residential care facility for the elderly shall provide written notice to a resident, the resident’s responsible party...within 10 days The department commences proceedings to... revoke the license. This requirement is not met as evidenced by Based on interviews and record review, the licensee did not comply with the section cited above. The facility did not provide a written notice to residents and resident's responsible party about Department proceeding to revoke the facility's license. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee states they will inform with a written notice to all residents and resident's responsible party the Department is commencing proceedings to revoke the facility's license. Licensee will send a copy of the written notice and proof they provided written notices to the resident and resident's responsible party to CCLD via email to edward.kim@dss.ca,gov by POC due date May 22, 2026.

Deadline recorded: May 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.38(e)

Regulation authority

HSC

What the official deficiency says

1569.38(e) Upon providing the notice... the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility... This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above. The facility did not post a notice about the Department commencing proceedings to revoke the facility's license. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee state they will post the notice and meet all the requirements for HSC 1569.38(e). They will send proof to CCLD via email to edward.kim@dss.ca.gov by POC due date May 22, 2026.

Deadline recorded: May 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 (e)(2) ... Faucets used by residents for personal care ... shall deliver hot water. Hot water temperature controls shall be maintained...to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. LPA observed resident bathrooms hot water temperature measured between 124.8 degrees F and 125.6 degrees F. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Deficiency cleared during the visit. Facility adjusted the water temperature for resident bathrooms that measured at 118.6 degrees F and 120.0 degrees F Civil Penalty assessed for repeat violation.

Deadline recorded: May 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above. LPA observed R1's room had a hole in the wall behind the recliner chair. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2026 Plan of Correction Licensee stated they will fix the hole in the wall in R1's bedroom. They will send a photo of the fixed hole in the wall to CCLD via email edward.kim@dss.ca.gov by POC due date April 22, 2026.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in one out of five residents. LPA observed that R2 did not have a completed pre-appraisal on file at the time of the visit. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2026 Plan of Correction Licensee stated they will provide R2's missing pre-appraisal needs and service plan to CCLD via email to edward.kim@dss.ca.gov by POC due date April 22, 2026.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPA observed last emergency drill was conducted on 10/23/2025. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2026 Plan of Correction Licensee stated they will send a current Emergency disaster drill and a document that they have read HSC 1569.695(c) and sign they understand and will comply with the regulation to CCLD via email to edward.kim@dss.ca.gov by POC due date April 22, 2026.

Official classification

Type A

Official code

87211(d)(4)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (d) The licensee shall notify the Department... all residents, and... their representatives, in writing within two business days of any of the following... (4) The licensee receives a written notice of default of payment of rent... This requirement is not met as evidenced by: Based on Licensee interview, Licensee did not comply with the section cited above as they received notice of default on the mortgage for the facility due to being five months behind on mortgage payments and they have not provided any written notice to any resident or their family.

Official plan of correction

Licensee to provide written notice to residents and their representatives of written notice they received regarding default on the mortgage for the facility and a copy of written notice to residents will be provided to LPA Edward Kim via email by POC due date March 26, 2026.

Deadline recorded: Mar 26, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

Liability insurance; coverage requirements: ..all residential care facilities for the elderly.. shall maintain liability insurance covering injury to residents and guests... This requirement was not met evidenced by Based on observation, interviews, and records reviewed, the Licensee did not ensure there was RCFE liability insurance for the facility. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee stated they will provide required insurance and to provide proof to CCLD via email edward.kim@dss.ca.gov by POC due date March 26, 2026.

Deadline recorded: Mar 26, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87213

Regulation authority

CCR

What the official deficiency says

87213 Finances: The licensee shall have a financial plan... shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency... This requirement was not evidenced by: Based on observation and records reviewed, the Licensee did not ensure and provide staff have been paid on schedule. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee stated that they will provide a written plan to LPA on when they will submit the requested documents on how they will address the owed wages of staff. The Licensee agreed to provide LPA the written plan via email or fax by POC date March 12, 2026.

Deadline recorded: Mar 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

Liability insurance; coverage requirements: ..all residential care facilities for the elderly.. shall maintain liability insurance covering injury to residents and guests.. This requirement was not met evidenced by: Based on observation, interviews, and records reviewed, the Licensee did not ensure there was RCFE liability insurance for the facility. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee stated they will provide required insurance and to provide proof to CCLD via email edward.kim@dss.ca.gov by POC due date March 3, 2026. Civil Penalty assessed for repeat violation.

Deadline recorded: Mar 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.This requirement was not met as evidenced by: Based on observations and interviews, the licensee did not comply with the section cited above. LPA observed the fan in the patio room was not operating. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated they will fix the fan in the patio area to be operational and send evidence of correction through email to CCLD via email to edward.kim@dss.ca.gov by POC due date March 9, 2026. Civil Penalty assessed for repeat violation.

Deadline recorded: Mar 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

Liability insurance; coverage requirements: ..all residential care facilities for the elderly.. shall maintain liability insurance covering injury to residents and guests.. This requirement was not evidenced by: Based on observation, interviews, and records reviewed, the Licensee did not ensure there was RCFE liability insurance for the facility. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee agrees to have the required insurance and to provide proof to the Agency (CCL) by the POC due date.

Deadline recorded: Feb 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

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: 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.

Official plan of correction

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.

Deadline recorded: Feb 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation: (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents ...shall be.. not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirment was not evidenced by: Based on observation, the Licensee did not ensure the water measured within regulatory requirements as the hot water temperature measured between 131.5 and 132.8 degrees Fahrenheit. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee was advised to adjust the hot water temperature to be within regulatory requirements. LPA will conduct a subsequent visit to measure the hot water temperature.

Deadline recorded: Feb 18, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87213

Regulation authority

CCR

What the official deficiency says

87213 Finances: The licensee shall have a financial plan.. shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency... This requirement was not evidenced by: Based on observation and records reviewed, the Licensee did not provide all the requested documents to Community Care Licensing as agreed upon. Additionally, the Licensee did not ensure staff have been paid on schedule. This poses an immedate health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee stated that they will provide a written plan to LPA on when they will submit the requested documents on how they will address the late pay of staff wages. The Licensee agreed to provide LPA the written plan via email or fax by POC date.

Deadline recorded: Feb 18, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

§1569.605 Liability insurance; coverage requirements: ..all residential care facilities for the elderly.. shall maintain liability insurance covering injury to residents and guests.. This requirement was not evidenced by: Based on observation, interviews, and records reviewed, the Licensee did not ensure there was RCFE liability insurance for the facility. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee stated that he will create a written plan on how he will obtain RCFE liability insurance for the facility. The Licensee agreed to provide LPA the written plan via email or fax by POC date.

Deadline recorded: Feb 18, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a)...the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances,... and other similar items ... are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not comply with the section cited above. LPA observed the right cabinet door under the kitchen sink was not locked with cleaning supplies. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Cleared during the visit. Staff installed a lock to the cabinet door under the kitchen sink. It is now locked and secured.

Deadline recorded: Feb 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not comply with the section cited above. PA observed the fan and the light were not turning on in the patio area. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated they will fix the light and fan in the patio area to be functioning and send evidence of correction through email to CCLD via email to edward.kim@dss.ca.gov by POC due date February 19, 2026.

Deadline recorded: Feb 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.652(c)

Regulation authority

HSC

What the official deficiency says

1569.652(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual... within 15 days. This requirement is not met as evidenced by Based on record review, interview, and observation, the licensee did not comply with the section cited above. A refund was not issued to R1’s responsible party who paid for the month of October. This poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee states they will pay a refund of $2335.48 to R1’s Responsible Party who paid the October payment and will send proof of payment to CCLD via email to Edward.kim@dss.ca.gov by POC due date January 23, 2026. A Civil Penalty was assessed for a repeated violation for deficiency on HSC 1569.652(c) within the year.

Deadline recorded: Jan 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.652(c)

Regulation authority

HSC

What the official deficiency says

1569.652(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual... within 15 days. This requirement is not met as evidenced by Based on record review, interview, and observation, the licensee did not comply with the section cited above. A refund was not issued to R1’s responsible party who paid for the month of September. This poses a potential health and safety risk to persons in care. ***This is an amended report***

Official plan of correction

Licensee states they will pay a refund of $1116.67 to R1’s Responsible Party who paid the September payment and the licensee will send proof of payment to CCLD via email to Edward.kim@dss.ca.gov by POC due date January 14, 2026.

Deadline recorded: Jan 14, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.652(c)

Regulation authority

HSC

What the official deficiency says

1569.652(c)A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual... within 15 days. This requirement is not met as evidenced by: Based on observations record review, and interviews, facility did not issue a refund of $1174.19 to the resident which poses a potential personal rights risk to persons in care.

Official plan of correction

Licensee states they will send a refund to R1 for $1174.19 and send proof of copy to CCLD via email to Edward.kim@dss.ca.gov by POC due date July 2, 2025.

Deadline recorded: Jul 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.626(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: (2) Eight hours of in-service training per year on the subject of serving residents with dementia. This training shall be developed in consultation with individuals or organizations with specific expertise in dementia care or by an outside source with expertise in dementia care. In formulating and providing this training, reference may be made to written materials and literature on dementia and the care and treatment of persons with dementia. This training requirement may be satisfied in one day or over a period of time. This training requirement may be provided at the facility or offsite and may include a combination of observation and practical application. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care. LPA did not observe eight hours of Dementia in-service training.

Official plan of correction

POC Due Date: 04/16/2024 Plan of Correction