331800471-2-10-2023-18-AS-EMAN-CPCTJ3-20230224134541

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800471
Report Date: 02/10/2023
Date Signed: 02/10/2023 11:24:16 AM

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
12/13/2021 and conducted by Evaluator Melody Brown

COMPLAINT CONTROL NUMBER: 18-AS-20211213104627

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:	0	CENSUS: 0	DATE:	02/10/2023
		ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Chief Executive Officer Betty Dominici		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff do not assist residents with incontinence care in a timely manner
Staff do not bathe residents regularly
Staff do not groom residents regularly
Facility does not provide quality food to residents
Staff do not serve resident's meals in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown met with Chief Executive Officer Betty Dominici at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office 02/10/2023 at 11:00 AM to deliver the findings of the above allegations. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews and a review of pertinent documentations.

The investigation was conducted by LPA Melody Brown. The investigation consisted of file review and interviews with relevant parties. The first allegation indicates Staff do not assist residents with incontinence care in a timely manner. Interviews with residents and staffs, revealed that all staff assists residents with incontinent care and staff checks on residents on incontionent care every two (2) hours.

***Continuation on 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: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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-20211213104627

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: 02/10/2023

NARRATIVE

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The second allegation indicates Staff do not bathe residents regularly. Staff #1 (S1) provided residents shower schedule to LPA Brown and LPA Brown observed that Staffs provide bathe or shower to all residents per schedule. Interviews with residents and staffs revealed that all residents are being provided bathe/shower by staffs two (2) to three (3) times per week per their shower schedule.

The third allegation indicates Staff do not groom residents regularly. Interviews with residents and staffs revealed that all staffs are assisting all residents in their grooming every day. Also, residents and staffs reported that no incident happened at the facility where a staff failed to groom residents regularly because all staff provides grooming to residents after their bathe/shower.

The fourth allegation indicates Facility does not provide quality food to residents. Residents and staffs interview and documents review revealed the facility provides quality food to residents and no incident occurred where residents were not served quality food. During the facility visit last 04/08/2022, LPA Brown observed residents eating lunch and they were served protein, carbohydrates, vegetables, choice of desert and drinks. LPA Brown reviewed facility menu and LPA Brown confirmed that residents were served the meal indicated in the facility menu for the day.

The fifth allegation indicates Staff do not serve resident's meals in a timely manner. Interviews with residents and staffs revealed that meals were served to residents in a timely manner, per meal schedule. During the facility visit last 04/08/2022, LPA Brown observed the residents in the dining area and residents’ meals were served in a timely manner, per meal schedule.

Based on interviews and records review, the allegation Staff do not assist residents with incontinence care in a timely manner (Allegation #1), Staff do not bathe residents regularly (Allegation #2), Staff do not groom residents regularly (Allegation #3), Facility does not provide quality food to residents (Allegation #4) and Staff do not serve resident's meals in a timely manner (Allegation #5) are 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.

An exit interview was conducted, where this report (LIC9099) was discussed and provided to Chief Executive Officer Betty Dominici.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC9099 (FAS) - (06/04)

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