331800471-8-11-2022-56-AS-KCLS-CNELDR-20230125074019

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800471
Report Date: 08/11/2022
Date Signed: 08/11/2022 02:55:25 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
08/05/2022 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220805125153

FACILITY NAME:	VILLA DE ANZA		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: 93	DATE:	08/11/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kenny Espinal		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff do not accorded dignity in their relationships with resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding an allegation that staff do not accord dignity in their relationships with resident. LPA met with Executive Director Kenny Espinal and discussed the elements of the allegations. Details were not specific as to which residents are not accorded dignity to. Director Espinal is not familiar with any relationships with residents that not afforded such dignity. No information was given as to statements that have been made nor witnesses that confirm such statements.

Based on the information obtained there is not enough evidence that staff do not accorded dignity in their relationships with resident. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

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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