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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800223
Report Date: 07/12/2024
Date Signed: 07/12/2024 03:42:40 PM

Document Has Been Signed on 07/12/2024 03:42 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: 100CENSUS: 92DATE:
07/12/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:20 AM
MET WITH:Teresa Mapilis, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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Regional Manager, Reyna Lacey, and Licensing Program Analyst (LPA), Stephanie Martinez, made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was greeted and allowed to enter the facility to conduct the inspection. On today’s visit the LPA met with Administrator, Teresa Mapilis, and Business Office Manager (BOM), Nicole Anguiano. They were notified of the purpose for the visit.

PHYSICAL PLANT: The Licensee appears to be operating the facility within the conditions and limitations specified on the license. Residents appear to be protected against immediate hazards. Outdoor and indoor passageways are kept free of obstruction. No pool or body of water was observed on the property. According to the Administrator, there are no weapons kept on the property. Disinfectants, cleaning solutions, and poisons were inaccessible to residents in care. A comfortable temperature was being maintained in each building on the property. There was sufficient lighting in resident bedrooms to ensure the comfort and safety of residents. The hot water was tested in several resident bedrooms and observed to be within regulatory requirements. Toilets, hand washing and bathing facilities were kept safe, sanitary, and in operating condition. Additional equipment for physically handicapped clients is available. The smoke and carbon monoxide alarms are being monitored by alarm central and recently inspected by the county fire department. Corrections requested by the fire department were completed on 07/08/24 and 07/09/24. The interior and exterior areas of the facility were observed to be clean and safe.

FOOD SERVICE: There was a variety of food which appeared to be selected and stored in a safe and healthful manner. Food supply of nonperishable and perishable foods was sufficient. Sufficient supplies for resident's dinning use was observed to be available.

RECORD REVIEW: Staff files had required training; including, but not limited to, First Aid/CPR, Reporting
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 07/12/2024
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Requirements, and Emergency and Disaster Training. Training on special health conditions was observed on file. Hospice Care Plan was observed on file for resident in care. Staff present had the required criminal record clearances. Admission Agreement, Medical Assessment (Physician's Report), Assessments, and Service Plans were observed on file for residents in care. Administrator Mapilis has an active Administrator's certificate, which expires on 12/30/2024. A fire drill was completed on 06/05/2024. The facility currently has 18 residents in care receiving hospice services; which is within their Hospice Waiver limit. The Licensee corporation is active with the California Secretary of State and proof of current Limited Liability Insurance was observed to be in place.

MEDICATION: Two of four medication carts were inspected. Medications were labeled and maintained in compliance with label instructions and State and Federal law. Medications were observed to be safe, locked, and inaccessible to residents in care.

No deficiencies have been cited at this time. This report was reviewed with Administrator Mapilis and a copy was provided.

NOTE: LPA left the facility at 1:00 PM and returned at 1:30 PM.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC809 (FAS) - (06/04)
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