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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800471
Report Date: 08/10/2021
Date Signed: 08/11/2021 08:56:05 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:VILLA DE ANZA ASSISTED LIVINGFACILITY NUMBER:
331800471
ADMINISTRATOR:WILLIAM LEWALLENFACILITY TYPE:
740
ADDRESS:5881 EL PALOMINO DRIVETELEPHONE:
(951) 685-3333
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:144CENSUS: 93DATE:
08/10/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Taylor Collins - Executive DirectorTIME COMPLETED:
02:00 PM
NARRATIVE
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An Informal Meeting was conducted today via Microsoft Teams due to COVID-19 in order to discuss recent concerns. The Informal Meeting was requested by the Licensee due to the large number of complaint investigations that have been opened for the facility in the last two months. Persons present at today’s meeting were: Licensing Program Manager (LPM) Joel Esquivel, Licensing Program Analyst (LPA) Crystal Colvin, Licensee & CEO A&A Senior Living Betty Dominici, COO for A&A Senior Living Kamal Grewal, Chief Compliance Officer Raj Thandi, Legal Counsel Joel Goldman, and Executive Director Taylor Collins.

Below are the topics that were addressed during the Informal Meeting tele-visit:
  • Recent Open Complaint Investigations

  • Licensee's application to open additional facilities

  • Suggestion for facility to hold council meetings with residents to address concerns

  • Deficiencies cited 7/28/21 for substantiated complaint (#18-AS-20210723105609)

  • Deficiencies cited 6/14/21 for Case Management Visit


LPM Joel Esquivel and LPA Crystal Colvin offered Licensee Betty Dominici Technical Support Program (TSP) Assistance, which the Licensee declined at this time.

An exit interview was conducted and a copy of this report was provided via email to Executive Director Taylor Collins for signature.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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