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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800223
Report Date: 02/23/2024
Date Signed: 02/23/2024 11:04:49 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
01/05/2024 and conducted by Evaluator Jacqueline Shaw Ross
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240105081727
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: 88DATE:
02/23/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nicole Anguiano, Business Office ManagerTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Resident was physically assaulted by another resident which resulted in injuries due to lack of supervision.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Jacqueline Shaw Ross made an unannounced visit to deliver findings for the allegations noted above. LPA met with Nicole Anguiano, Business Office Manager, and explained the purpose of the visit and the elements of the allegations. The investigation consisted of observations, interviews, and records review.

On 1/5/2024, Community Care Licensing received an allegation that a resident was physically assaulted by another resident that resulted in injuries. It was reported that R2 became agitated with R1 over a comment that was made by R1. R2 began yelling at R1 and grabbed R1's left arm, leaving a bruise. R1 called the police, and police arrived however no charges were filed. LPA interviewed staff who corroborated that the incident did occur. The assault was witnessed by a newly hired staff member who was taking a video training course. LPA interviewed R1 who stated there was concern there was not enough supervision which led to the assault.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
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 5
Control Number 18-AS-20240105081727
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: YORKSHIRE VILLAGE
FACILITY NUMBER: 331800223
VISIT DATE: 02/23/2024
NARRATIVE
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Staff indicated no other staff were around during the assault except for the newly hired staff member. LPA interviewed R2 but was unable to finish the interview due to R2 became verbally aggressive to LPA. LPA reviewed documents pertinent to the investigation that included facility incident reports, client records and photos of the injury. Based on LPA’s observations, interviews conducted, and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099 D. An exit interview was conducted and a copy of this report was provided along with Appeal Rights.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20240105081727
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: YORKSHIRE VILLAGE
FACILITY NUMBER: 331800223
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2024
Section Cited
CCR
87411(A)
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87411 Personnel Requirements- General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement is not met as evidenced by:
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Facility agrees to revisit the schedule for the assisted living building that may include increasing more staff or have more frequent checks to ensure there is consistent supervision, as well as
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Based on interviews and records review, the licensee did not ensure facility personnel to be sufficient in numbers and competent to provide the services necessary to meet resident needs.
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provide additional training on supervision and safety of residents. Facility will provide training log and revised staffing schedule to the Department by POC date of 3/22/2024.
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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: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
01/05/2024 and conducted by Evaluator Jacqueline Shaw Ross
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240105081727

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: 88DATE:
02/23/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nicole Anguiano, Business Office ManagerTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Staff did not provide a safe and comfortable environment for resident.
INVESTIGATION FINDINGS:
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On 1/5/2024, Community Care Licensing received an allegation that staff did not provide a safe and comfortable environment for resident. It was reported that R2 did not feel safe from R2. LPA conducted observation, interviews and record reviews. Interview with Teresa Mapilis, Executive Director, indicate the facility has made attempts to provide a safe and comfortable environment for resident by offering to temporarily move R1 to a different building to create distance from R2, however R1 did not want to move. Interview with R1 revealed R1 feels safe in the facility and comfortable with staff but does not feel safe from R2. Client records reveal staff has had ongoing issues with R2 displaying verbal aggression to multiple staff and residents. The Executive Director also indicated there have been several attempts to relocate R2 to a facility that is better suited to meet their needs however R2 has refused, and the facility iscurrently unable to obtain authorization to relocate R2. The facility in the meantime is checking on R1 more frequently to ensure a safe and comfortable environment. LPA reviewed staffing schedules was informed the staff schedules one caregiver per shift for each building and is unable to increase staffing.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20240105081727
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: YORKSHIRE VILLAGE
FACILITY NUMBER: 331800223
VISIT DATE: 02/23/2024
NARRATIVE
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Based on LPA’s observation, interview(s) conducted and record review(s), the preponderance of evidence shows that the allegations is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, a copy of this report, appeal rights was provided to Nicole Anguiano, Business Office Manager.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5