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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800223
Report Date: 01/15/2025
Date Signed: 01/15/2025 02:01:36 PM

Document Has Been Signed on 01/15/2025 02:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:YORKSHIRE VILLAGEFACILITY NUMBER:
331800223
ADMINISTRATOR/
DIRECTOR:		TERESA MAPILISFACILITY TYPE:
740
ADDRESS:26933 CORNELL STTELEPHONE:
(951) 658-1068
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY: 100TOTAL ENROLLED CHILDREN: 0CENSUS: 87DATE:
01/15/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Nicole Anguiano, business office managerTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA), Seo Jeon, conducted an unannounced visit to the facility for a case management visit. The LPA was allowed entrance into the facility and met with Nicole Anguiano, Business Office Manager. The LPA informed them of the purpose for the visit.

A report was received by the Department from the facility on 10-31-2024 regarding an incident between Resident #1 (R1) and Resident #2 (R2).

LPA toured the facility and observed all facility utilities to be on and operating without issue. LPA did not observe any immediate health and safety concerns. LPA spoke to Anguiano about the incident report received on 10-31-2024. Anguiano informed LPA that a staff member was present during the entire incident pointing that there was enough staff coverage for residents in care. The staff member immediately redirected both R1 and R2. Anguiano informed LPA that R2 was relocated to Building A 2 weeks after the incident for safety of both residents.

LPA did not observe any health and safety concerns at this time. There are no deficiencies being cited, per California Health & Safety Code and Code of Regulations, Title 22.



An exit interview was conducted, a copy of this report were provided to Nicole Anguiano, business office manager.
Rikesha StampsTELEPHONE: (951) 212-0616
Seo JeonTELEPHONE: 951-248-0309
DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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