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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800223
Report Date: 06/11/2026
Date Signed: 06/12/2026 05:14:53 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
05/28/2026 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20260528162825
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: 94DATE:
06/11/2026
UNANNOUNCEDTIME BEGAN:
07:10 AM
MET WITH:Medication Technician Ligaya CarterTIME COMPLETED:
06:15 PM
ALLEGATION(S):
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Licensee did not follow reporting requirements
INVESTIGATION FINDINGS:
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On 6/11/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering the complaint findings into the allegation listed above. LPA Flores met with Medication Technician Ligaya Carter and explained the purpose of the visit. The investigation is summarized as follows:

On 5/28/2026, Community Care Licensing (CCL) received a complaint alleging Licensee did not follow reporting requirements. An interview conducted with Resident #1’s (R1’s) responsible party reports that R1 experience a fall in the morning hours of 5/27/2026 and was not informed by staff. R1’s responsible person reports that they received a text message from Relevant Party #1 (RP1) on 5/27/2026 advising of a fall R1 experience which resulted in a hematoma to the back of the head that measure roughly the size of a golf ball.

(Continue to LIC9099)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2026
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 3
Control Number 18-AS-20260528162825
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: 06/11/2026
NARRATIVE
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(Continuation from LIC9099)

The interview conducted with RP1 corroborated R1’s responsible party’s account of contacting R1’s responsible party at approximately one o’clock in the afternoon informing them of a fall R1 experienced. Interviews with Administrator reported that they contacted R1’s responsible party via text message on 5/28/2026 to inform R1’s responsible party of the fall incident and a FAX was provided to the CCL on 5/28/2026. A records review conducted of CCL’s Unusual Incident Reports confirmed that an incident report was not received for the incident dating 5/27/2026. LPA requested a copy of the FAX transmittal receipt. An interview conducted with the Administrator reports that the facility does not maintain copies of the FAX transmittal receipt to confirm if the FAX was successful received by CCL.

Therefore, the allegation of Licensee did not follow reporting requirements is deemed substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid as the preponderance of the evidence standard has been met. California Code of Regulations Title 22 is being cited on the attached LIC9099D.

An exit interview was conducted with Medication Technician Ligaya Carter and a copy of the LIC9099, LIC9099C, LIC9099D, and appeal rights will be provided to the Business Office Manager Nicole Anguiano.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20260528162825
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: 06/11/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/25/2026
Section Cited
CCR
87211(a)(1)(D)
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(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence..
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Upper management is to review Reporting Requirements, Section 87211, and provide the department with a signed affidavit confirming that the section was read. The facility will maintain copies of FAX transmittal receipts and/or email copies of any incident reports sent to the Department.
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(D) Any incident which threatens the welfare, safety or health of any resident... This requirement was not met with evidence: Facility not maintaining proof of FAX transmittal receipt verifying the UIR was forwarded to CCL and CCL not having proof of receipt of the incident on 5/27/2026.
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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: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3