331800223-6-21-2024-18-AS-JDHS-D72MRV-20240710095054

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800223
Report Date: 06/21/2024
Date Signed: 06/21/2024 02:50:21 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/17/2024 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240117092257

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:	06/21/2024
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	ADMINISTRATOR, TERESA MAPILIS		TIME COMPLETED:	02:58 PM

ALLEGATION(S):

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Staff are administering medication to resident not consented by POA.
Staff are not meeting resident's hygiene needs.
Staff did not ensure resident used her walking device.

INVESTIGATION FINDINGS:

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On June 21, 2024, Licensing Program Analyst (LPA), Venus Mixson conducted an unannounced visit and met with the Administrator, Teresa Mapilis.

The visit was conducted to provide the findings for the investigation pertaining to the listed allegations. LPA interviewed staff, residents, and witness and conducted record reviews. LPA was unable to interview Resident Number 1 (R1) due to Resident refusing to speak with department staff.

On January 17, 2024, Community Care Licensing (CCL) received a complaint that Staff are administering medication to resident not consented by POA, Staff are not meeting resident's hygiene needs, and Staff did not ensure resident used their walking device.

Regarding the allegation of Staff are not meeting resident's hygiene needs, it was reported that R1 was brought into the doctor’s office and was observed to be dirty, smelled like urine. On another occasion it was reported that R1's diaper was observed to be on the outside of their clothes, R1's skin was dry and cracked and R1's was reported to have dirt on their face. Information obtained from interviews stated the facility staff are instructed to give R1 reminders and to assist R1, but at no time are the staff to force R1 to practice the daily hygiene. A review of documentation indicated that R1 refuses to participate in hygiene practices regularly.

Regarding the allegation of Staff are administering medication to resident not consented by POA, it was reported that Staff are administering medication to resident not consented by POA.
CONTINUED ON LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2024

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-20240117092257

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: YORKSHIRE VILLAGE	FACILITY NUMBER: 331800223
	VISIT DATE: 06/21/2024

NARRATIVE

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CONTINUED FROM 9099
It was advised that the primary care doctor prescribed R1 two specific medications. Information obtained from interviews with facility staff stated staff follow R1's plan of care, service plan as well as the Physicians orders. The records review indicated that there were no medications being administered to R1 that were not prescribed by the attending doctor.

Regarding the allegation of Staff did not ensure resident used their walking device, it was reported that R1 was taken to the doctors without their walking device. Information obtained from interview with the Administrator and facility staff advised that R1 is supposed to use their walker when ambulating. It was stated that there was an incident where R1 was transported to see their primary doctor and R1 was trying to hit Staff Member with their walker. Staff Member was able to calm R1 down and properly use their walker to assist with ambulating. Upon arrival to the doctor’s office, R1 refused to use the walker. The driver, which was also a staff member, escorted R1 into the doctor’s office. Information obtained from additional witness stated that R1's walker was present and available for use.

Based on interviews, reviews of the documents, observations, and the inability to interview R1, the allegations of Staff are administering medication to resident not consented by POA, Staff are not meeting resident's hygiene needs, and Staff did not ensure resident used a walking device have been deemed "Unsubstantiated." An allegation finding of "unsubstantiated" means although the allegations may have happened or are valid, there is not a preponderance of evidence strand to prove the alleged violation(s), did or did not occur; therefore, the allegations are unsubstantiated.

An exit interview was conducted, a copy of this report, along with the appeal rights were provided to the Administrator, Teresa Mapilis.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC9099 (FAS) - (06/04)

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