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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800223
Report Date: 06/17/2026
Date Signed: 06/17/2026 04:32:06 PM

Unsubstantiated


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: 90DATE:
06/17/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Business Office Manager Nicole AnguianoTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Resident sustained an injury due to staff neglect or physical abuse
INVESTIGATION FINDINGS:
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On 6/17/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering the investigative findings into the allegation listed above. LPA Flores met with Business Office Manager Nicole Anguiano 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 Resident #1 (R1) sustained an injury due to staff neglect or physical abuse. An interview conducted with Reporting Party (RP) reports that on 5/27/2026 R1 experience a fall in the facility, which was a result of neglect not caused directly by physical abuse. RP learned of the incident from R1’s responsible person. An interview conducted with R1’s responsible person reports that R1 is known to be a fall-risk and has experienced an increase in falls since residing in the facility.

(Continue to LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026
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 2
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: 06/17/2026
NARRATIVE
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(Continuation from LIC9099)
R1’s responsible person reports that if staff were properly supervising R1, R1 would never have fallen. R1’s responsible person reports that R1 does not need a one-on-one caregiver but believes that if staff were providing adequate supervision the fall could have been prevented. LPA requested and collected a copy of an incident report for the fall R1 experience on 5/27/2026. An incident report dated 5/27/2026 details that at 10:39AM, R1 was in the dining area, standing, and holding a chair when she fell back. An interview conducted with Staff #1(S1) reports that they were in the dining room ending an activity with the residents and began loading the activity cart. (S1) reports hearing a loud thump and immediately rushed towards the noise. S1 reports observing R1 lying on their back. S1 reportedly placed their hand under R1’s head to provide support. As S1 was providing support, S1 recalls feeling a lump forming on the back of R1’s head. Interviews with Staff #2 (S2) reports that they were assisting Staff #3 (S3) with the facility’s care track app while occasionally glancing back at the resident. S2 reports hearing a loud thud; S2 rushed towards R1 after observing R1 lying flat on their back. Interview with Staff #4 (S4) reports that they were in the Business Office when they heard a loud thump. S4 stated that they rushed out of the Business Office and into the dining room where R1 was observed lying flat on their back. Interviews with S2 and S4 confirmed that R1 sustained a lump on the back of the head, and no additional injuries were observed. LPA attempted to interview R1 but due to R1’s cognitive abilities, the interview attempt was unsuccessful. LPA attempted to conduct an interview with Staff #3 (S3) but S3 did not have a great recollection of the incident occurring on 5/27/2026. LPA Flores obtained a (22) twenty-two second clipped video footage of the incident. LPA observed R1 standing in the dining room, holding onto the back support of a chair. S1, S2, and S3 were observed holding onto a cellphone facing the opposite direction of R1. R1 was observed suddenly falling backwards pulling the chair onto the ground. S1 and S2 were observed immediately responding to the fall by rushing towards R1 then followed S3 and S4 just seconds after. The clipped video ended once staff approached R1.

Therefore, the allegation of resident sustained an injury due to staff neglect or physical abuse is deemed unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegations are unsubstantiated at this time.

An exit interview was conducted, and a copy of this report was provided to Business Office Manager Nicole Anguiano.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2