331800471-4-18-2022-18-AS-EMAN-CE6N8F-20220506101413

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800471
Report Date: 04/17/2022
Date Signed: 04/18/2022 01:03:35 PM

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/30/2021 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210930161548

FACILITY NAME:	VILLA DE ANZA ASSISTED LIVING		FACILITY NUMBER:	331800471
ADMINISTRATOR:	KENNY ESPINAL		FACILITY TYPE:	740
ADDRESS:	5881 EL PALOMINO DRIVE		TELEPHONE:	(951) 685-3333
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY:	144	CENSUS: 77	DATE:	04/17/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Executive Director Kenny Espinal		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Residents are not being properly fed while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility 04/18/2022 at 11:30 AM to deliver findings for the above allegation with Executive Director Kenny Espinal. LPA Brown introduced herself and explained the purpose of today’s visit. The investigation consisted of interviews with pertinent parties and records review.

The allegation indicates Residents are not being properly fed while in care. LPA Brown did not find evidence to corroborate the allegation. Interviews with residents and staffs indicated residents are properly fed while in care. Residents and staffs reported that breakfast, AM snack, lunch, PM snacks and dinner were slways served and available to residents. In addition, interviews with residents and staff also revealed that second serving of foods are available to all residents if they request for it. LPA Brown observed the dining area and good portion of food were served to all residents during the visit.
***Continution in LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20210930161548

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: VILLA DE ANZA ASSISTED LIVING	FACILITY NUMBER: 331800471
	VISIT DATE: 04/17/2022

NARRATIVE

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Based on interviews and records review, the above allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies were cited during this visit.

An exit interview was conducted, and a copy of this report (LIC9099) was discussed and provided to Executive Director Kenny Espinal.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2022

LIC9099 (FAS) - (06/04)

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