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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800223
Report Date: 05/07/2026
Date Signed: 05/07/2026 03:10:29 PM

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
08/20/2024 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240820142126
FACILITY NAME:YORKSHIRE VILLAGEFACILITY NUMBER:
331800223
ADMINISTRATOR:TERESA MAPILISFACILITY TYPE:
740
ADDRESS:26933 CORNELL STTELEPHONE:
(951) 658-1068
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:100CENSUS: 96DATE:
05/07/2026
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Marielle Figueroa, Wellness DirectorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Staff mismanaged residents’ medications
Staff did not comply with reporting requirements
Staff did not ensure hazardous items were inaccessible to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to deliver findings of the above allegations. LPA met with Marielle Figueroa, Wellness Director, and informed them of the purpose of the visit. The Department’s investigation involved interviews with staff and residents and review of records.

On 08-20-2024, Community Care Licensing (The Department) received a complaint report with the following allegations.

It was alleged that staff mismanaged residents’ medications. Specifically, information indicated that Staff #1 (S1) dispensed Resident #2’s (R2) medication to Resident #1 (R1). During an interview with LPA, Staff #2 (S2) stated the error occurred in late July 2024. S2 clarified that while the medication and dosage were identical for both residents, the dose given to R1 was taken from R2’s container.
Continued on LIC9099-C....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
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 6
Control Number 18-AS-20240820142126
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: 05/07/2026
NARRATIVE
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An LPA’s records review confirmed that R1 and R2 had one same prescribed medication. Based on interviews conducted and records review, the Department’s investigation provided enough information to corroborate the allegation that staff mismanaged residents’ medications. This allegation is substantiated.

It was alleged that staff did not comply with reporting requirements. Information received indicated that staff did not inform R1’s responsible person when the medication error occurred. LPA conducted an interview with R1’s relevant party, who stated that staff never informed about the medication incident. LPA’s records review revealed that staff had not reported the medication error to the Department. Based on interviews conducted and records review, the Department’s investigation provided enough information to corroborate the allegation that staff did not comply with reporting requirements. This allegation is substantiated.

It was alleged that staff did not ensure hazardous items were inaccessible to residents. Information received indicated that Resident #3 (R3) took a knife from the facility kitchen while the door remained open. LPA’s record review revealed that R3 followed a staff member into the facility kitchen and took a knife on 07-21-2024. R3 waved the knife around and chased one of the staff members. 911 was called and R3 was placed under frequent check. Based on records review, the Department’s investigation provided enough information to corroborate the allegation that staff did not ensure hazardous items were inaccessible to residents. This allegation is substantiated.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where a copy of this report was provided, along with LIC9099-D, and Appeal Rights.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
08/20/2024 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240820142126

FACILITY NAME:YORKSHIRE VILLAGEFACILITY NUMBER:
331800223
ADMINISTRATOR:TERESA MAPILISFACILITY TYPE:
740
ADDRESS:26933 CORNELL STTELEPHONE:
(951) 658-1068
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:100CENSUS: 96DATE:
05/07/2026
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Marielle Figueroa, Wellness DirectorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
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5
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7
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9
Staff are not properly addressing pest infestation in facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to deliver findings of the above allegation. LPA met with Marielle Figueroa, Wellness Director, and informed them of the purpose of the visit. The Department’s investigation involved interviews with staff and residents and review of records.

On 08-20-2024, Community Care Licensing (The Department) received a complaint report with the following allegation.

It was alleged that staff are not properly addressing pest infestation in facility. Information received indicated that one of the buildings in the facility was infested with pests, and staff did not do anything to mitigate the pest infestation.

Continued on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 18-AS-20240820142126
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: 05/07/2026
NARRATIVE
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LPA obtained and reviewed pest control reports and invoices from June 2024 through August 2024 and observed that staff hired pest control company and treated all buildings in the facility every month. LPA toured the interior and exterior of the facility and did not observe any signs of pest infestation. Based on records review and observations, the Department’s investigation did not provide enough information to corroborate the allegation that staff are not properly addressing pest infestation in facility. This allegation is unsubstantiated.

A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.



An exit interview was conducted where a copy of this report was provided.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 18-AS-20240820142126
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: 05/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/14/2026
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be..., (4) The licensee shall assist residents with self-administered medications as needed.
This requirement was not met as evidenced by:
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Licensee agreed to provide in-service traning on medication management and send proof to LPA via email by the POC due date.
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Licensee did not ensure that staff dispense medication from correct resident's medication container. This posed potential health and safety risk to residents in care.
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Type B
05/14/2026
Section Cited
CCR
87211(a)(1)(D)
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87211 Reporting Requirements, (a) Each licensee shall furnish to the licensing agency such reports..., (1) A written report shall be submitted to the licensing agency..., (D) Any incident which threatens the welfare, safety or health of any resident.... This requirement was not met as evidenced by:
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Licensee agreed to provide in-service traning on reporting requiements and send proof to LPA via email by the POC due date.
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Licensee did not report the incident involving medication error to all relevant parties. This posed potential health and safety and personal rights risk to residents 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: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20240820142126
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: 05/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/14/2026
Section Cited
CCR
87309(a)
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87309 Storage Space and Access, (a) Except as specified in subsection (b), the licensee shall ensure that ... knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
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Licensee stated that in-service training was already conducted immediately after the incident and locked storage was purchased so that sharp and dangerous items are double locked along with locked kitchen door.
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This requirement was not met as evidenced by:
Licensee did not ensure knives were inaccessible to R3 who followed a staff member into kitchen and took a knife. This posed immediate health and safety risk to residents 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: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6