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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800223
Report Date: 09/16/2025
Date Signed: 09/16/2025 09:55:04 AM

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
05/31/2022 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220531160519
FACILITY NAME:YORKSHIRE VILLAGEFACILITY NUMBER:
331800223
ADMINISTRATOR:KNOOP, BENITAFACILITY TYPE:
740
ADDRESS:26933 CORNELL STTELEPHONE:
(951) 658-1068
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:100CENSUS: 85DATE:
09/16/2025
UNANNOUNCEDTIME BEGAN:
07:17 AM
MET WITH:Nicole Anguiano - Office ManagerTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff mismanaging medication.
INVESTIGATION FINDINGS:
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LPA Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Nicole Anguiano and explained the reason for the visit.

The investigation consisted of the following: On 6/1/22 LPA George conducted an initial investigation visit. On 9/10/25 LPA Flores contacted administrator via telephone and requested a copy of staff/resident roster. On 9/12/25 LPA interviewed 6 staff over the phone. On 9/15/25 LPA Flores conducted an unrelated complaint investigaiton visit and reviewed medication for 9 residents and interviewed 9 residents. On 9/16/25 LPA delivered findings for above allegations.

The investigation revealed the following: Regarding allegation: Staff are mismanaging medication. It is alleged that staff are mismanaging the residents medications.
(CONTINUED ON LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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-20220531160519
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: 09/16/2025
NARRATIVE
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Interviews with residents revealed 6 out of 9 residents had no concerns regarding their medications. 3 out of 9 residents were aware the facility staff had run out of their medications a few times in the past. Interviews with staff revealed there have not been medication errors, missed medication, or mismanagement of the residents’ medications. Medication review for Resident #1-9 (R1-R9) revealed the following: 7 out of 9 residents were missing one or more of their prescribed and/or as needed medication(PRN). Missing medications were observed as follow; R1 was missing Tramadol. R2 was missing Vitamin D2, Loperamide 2mg, Milk of magnesium, Naproxen 500mg. R4 was missing Levothyroxine 50mg, Diclofenac gel, Anti-Acid and bubble pack for Oxcarbazepine 600mg was observed with the back popped/tear for 18 pills that were placed back into the pack. R6 was missing Enolose 10mg. R7 was missing Omeprazole, Acetaminophen 325mg, Milk of magnesium, Nystatin 100,000 solution. R8 was missing Acetaminophen 325mg, Docusate 100mg Loperamide 2mg, Albuterol HFA90 inhaler. R9 was missing milk of magnesium. Per wellness coordinator, they recently conducted an audit and have requested refills for the medications. LPA Flores contacted the pharmacy to verify orders were place per facility’s records dated 9/11/25 and 9/12/25. Interview with pharmacist revealed, orders have not been placed for refills for 5 residents.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview was conducted and a copy of this report, LIC 9099D, and appeal rights were provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20220531160519
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: 09/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/17/2025
Section Cited
CCR
87464(f)(6)
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87464 Basic Services: (f) Basic services shall at a minimum include:(6) Arrangements to meet health needs,...

This requirement is not met as evidence by:
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Administrator will certify in writing that will provide training to staff, will obtain all missing medication, and ensure that medication list is current by POC due date: 9/17/25. Administrator will submit a copy of training provided, and picutres of medication missing for R1,R2,R4,R6,R7,R8,R9 by 9/23/25.
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Based on medication review and documents reviewed licensee did not ensure medications for R1,R2,R4,R6,R7,R8,R9 were available at the facility for the residents which poses an immediate risk to the health, safety, or personal rights of the persons in care.
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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.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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 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
05/31/2022 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220531160519

FACILITY NAME:YORKSHIRE VILLAGEFACILITY NUMBER:
331800223
ADMINISTRATOR:KNOOP, BENITAFACILITY TYPE:
740
ADDRESS:26933 CORNELL STTELEPHONE:
(951) 658-1068
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:100CENSUS: 85DATE:
09/16/2025
UNANNOUNCEDTIME BEGAN:
07:17 AM
MET WITH:Nicole Anguiano - Office ManagerTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents are not being provided medications as prescribed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Nicole Anguiano and explained the reason for the visit.

The investigation consisted of the following: On 6/1/22 LPA George conducted an initial investigation visit. On 9/10/25 LPA Flores contacted administrator via telephone and requested a copy of staff/resident roster. On 9/12/25 LPA interviewed 6 staff over the phone. On 9/15/25 LPA Flores conducted a unrelated complaint investigaiton visit and reviewed medication for 9 residents and interviewed 9 residents. On 9/16/25 LPA delivered findings for above allegations.

The investigation revealed the following: Regarding allegation: Residents are not being provided medications as prescribed. It is alleged that on 5/24/22 medication was not provided to resident in care. Interviews conducted with residents revealed 9 out of 9 residents stated to have received their medications and not missed their medications. (CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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-20220531160519
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: 09/16/2025
NARRATIVE
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R1 is no longer at the facility and was not able to be interviewed. Interviews with staff revealed there have not been medication errors, missed medication, or mismanagement of the residents’ medications. Medication review of 9 residents revealed facility staff did not have some of the residents medications. However, per the review the medications available had been provided to the residents in care. Therefore the allegation 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.

Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5