331800223-5-8-2025-18-AS-RSTS-DGHMYX-20250509100214

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800223
Report Date: 10/25/2024
Date Signed: 05/08/2025 12:28:57 PM

Unsubstantiated

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
08/29/2024 and conducted by Evaluator Seo Jeon

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240829145120

FACILITY NAME:	YORKSHIRE VILLAGE		FACILITY NUMBER:	331800223
ADMINISTRATOR:	TERESA MAPILIS		FACILITY TYPE:	740
ADDRESS:	26933 CORNELL ST		TELEPHONE:	(951) 658-1068
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	100	CENSUS: 92	DATE:	10/25/2024
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Nicole Anguiano, business office director		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Due to lack of supervision, resident got into a physical altercation with another resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced subsequent complaint visit to the facility and met with the Business Office Director, Nicole Anguiano, informing them of the purpose of the visit. Throughout the investigation, LPA interviewed staff and residents, reviewed files, and obtained supporting documentation to aid in determining the findings of the noted allegation.

On August 29, 2024, Community Care Licensing received a complaint report alleging that due to lack of supervision, a resident got into a physical altercation with another resident.

During LPA’s initial 10-day visit on August 30, 2024, a review of resident files revealed both Resident #1 (R1) and Resident #2 (R2) were residents at the facility.

Continued on LIC9099-C....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20240829145120

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: 10/25/2024

NARRATIVE

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Per review of monthly staff schedule, LPA verified the facility had sufficient staff coverage to meet the care and supervision needs of each resident. The facility had four (4) caregivers and one (1) med/tech to 36 residents at the time of the incident.

LPA conducted an interview with R1 regarding the alleged incident. During the interview, R1 recounted while they were walking through the hallway carrying their lunch plate, R2 suddenly and unexpectedly launched an aggressive attack on R1. R1 expressed surprise and confusion, noting they had no prior familiarity or interactions with R2. The commotion created by the incident drew the attention of two caregivers who were providing care to other residents nearby. The caregivers intervened and managed to re-directed R2, successfully preventing any further harm to R1. LPA also attempted to interview R2; however, R2 was unable to communicate due to their health condition.

LPA reviewed supportive documentation which detailed the resident-on-resident altercation and confirmed the incident was self-reported by the facility as per regulatory requirements. A review of the staff schedule confirmed there was sufficient staffing in numbers to provide care and supervision necessary to meet residents’ needs at the time of the incident.

Based on the interviews conducted, record reviews, and the verification of staff schedules, LPA determined the allegation that due to lack of supervision, a resident got into physical altercation with another resident is Unsubstantiated. A finding of Unsubstantiated means that the allegation may have happened or is valid, but there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted, and a copy of this report was provided.

***This is an amended version of the report created on 10-25-2024.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

LIC9099 (FAS) - (06/04)

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