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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800223
Report Date: 04/22/2024
Date Signed: 04/22/2024 02:44:09 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/17/2024 and conducted by Evaluator Stephanie Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240417082812
FACILITY NAME:YORKSHIRE VILLAGEFACILITY NUMBER:
331800223
ADMINISTRATOR:TERESA MAPILISFACILITY TYPE:
740
ADDRESS:26933 CORNELL STTELEPHONE:
(951) 658-1068
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:100CENSUS: 90DATE:
04/22/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Teresa Mapilis, AdministratorTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not notify responsible party of change of resident's health condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegation. The LPA met with Administrator, Teresa Mapilis, and informed her of the purpose for her visit.

A report was received by the Department alleging the facility did not notify family members of residents currently experiencing rashes. On this visit the LPA conducted staff and resident interviews, reviewed records and obtained copies of pertinent documentation. Nine resident interviews were conducted; of the nine, four residents reported they currently had a rash on their body. According to Administrator, Teresa Mapilis, there about seven residents in building B who currently have a rash. One third party interview revealed the responsible party of Resident One (R1) was not notified of the resident's rash. An interview with Administrator Mapilis revealed the responsible party of R1 was not notified by the facility due to the resident receiving services from a hospice agency. Administrator Mapilis reported the hospice agency would have reached out to R1's responsible party to notify them of the health condition. Therefore, based on interviews, this allegation
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie MartinezTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
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 18-AS-20240417082812
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: YORKSHIRE VILLAGE
FACILITY NUMBER: 331800223
VISIT DATE: 04/22/2024
NARRATIVE
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is deemed SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. This violation poses a potential threat to the health, safety, and personal rights of residents in care. A citation will be issued.

An exit interview was conducted with Business Office Manager (BOM), Nicole Anguiano. This report was reviewed, and a copy was provided, along with the LIC 811, and instructions on appeal rights.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie MartinezTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240417082812
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: YORKSHIRE VILLAGE
FACILITY NUMBER: 331800223
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2024
Section Cited
CCR
87468.1(a)(8)
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Personal Rights of Residents in All Facilities: (a) Residents in all RCFEs shall have all of the following...rights: (8) To have their representatives regularly informed by the licensee of activities related to care or services...This requirement was not met, as evidenced by: Based on interviews,
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The Administrator stated in-service training will be provided to staff regarding notifying family members of hospice residents of any health changes.
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the licensee did not ensure R1's right to have their representative informed of activities related to care was met. Admin. revealed the responsible party of R1 wasn't notified due to R1 receiving services from a hospice agency, who would have reached out to the responsible party for notification.
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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.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie MartinezTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3