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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800223
Report Date: 12/07/2021
Date Signed: 05/23/2023 09:07:45 AM

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
12/01/2021 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211201093042
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: 77DATE:
12/07/2021
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nicole Anguiano, Business Office ManagerTIME COMPLETED:
11:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff overmedicated resident.
Staff made resident dance for food.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jesse Gardner arrived at the facility unannounced to investigate the above allegations. LPA identified himself and discussed the purpose of the visit with Business Office Manager Nicole Anguiano and toured the facility.

It was alleged that Resident #1 (R1) left Yorkshire Village on November 4, 2021 because R1 felt they were being mistreated by the staff by having R1 take more medication than R1 should and making R1 dance for food.
This investigation consisted of record review, and interviews with relevant parties.

Through interviews with R1 and staff, LPA determined that R1 was not given or made to consume more medication that was ordered. Additionally, a record review of R1’s Medication Administration Record (MAR) indicated that R1 was receiving medication as ordered by their physician. Thus, this allegation was deemed to be UNSUBSTANTIATED.

Based on evidence obtained during today’s visit, LPA has determined that the above allegations are UNSUBSTANTIATED; meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.
An exit interview was conducted, and a copy of this report was provided. This is an amended version of the original report dated December 7, 2021.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
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 2
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
12/01/2021 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211201093042

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: 77DATE:
12/07/2021
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nicole Anguiano, Business Office ManagerTIME COMPLETED:
11:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident left the facility unsupervised.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jesse Gardner arrived at the facility unannounced to conduct an investigation for the above allegation. LPA identified himself and discussed the purpose of the visit with Business Office Manager Nicole Anguiano and toured the facility.

It was alleged that Resident One (R1) left the facility unsupervised. Through a record review, LPA determined that R1 was able to leave the facility unassisted. Thus, the allegation, "Resident left the facility unsupervised" was deemed to be UNSUBSTANTIATED, means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was discussed with Ms. Anguiano, and a copy of this report was provided along with a copy of the LIC811.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2