331800471-12-20-2023-18-AS-NBRN-CZ4R3K-20240102114004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800471
Report Date: 12/20/2023
Date Signed: 12/20/2023 10:22:17 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
07/06/2021 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210706142605

FACILITY NAME:	VILLA DE ANZA ASSISTED LIVING		FACILITY NUMBER:	331800471
ADMINISTRATOR:	WILLIAM LEWALLEN		FACILITY TYPE:	740
ADDRESS:	5881 EL PALOMINO DRIVE		TELEPHONE:	(951) 685-3333
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY:	0	CENSUS: 0	DATE:	12/20/2023
		ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Olevia Labeeb		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Insufficient staffing to meet resident's needs
Staff failed to assist resident in a timely manner
Staff left resident in wet clothing for extended periods of time
Staff failed to provide adequate food service
Staff failed to meet resident's hygiene needs
Staff made inappropriate comment towards resident
Untrained staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico met with Executive Director Olevia Labeeb at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to deliver the findings of the above allegations. LPA Rico explained the purpose of the requested Office Visit. The investigation consisted of interviews.

For the allegation, Insufficient staffing to meet resident's needs.

During interviews with staff, all staff indicated they were still meeting residents’ needs. During interviews with residents. All residents stated they did not notice if the facility was short staff. Residents indicated staff would still meet their needs.

For the allegation, Staff left resident in wet clothing for extended periods of time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

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-20210706142605

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VILLA DE ANZA ASSISTED LIVING	FACILITY NUMBER: 331800471
	VISIT DATE: 12/20/2023

NARRATIVE

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During interviews with staff, all staff stated they would not leave residents in wet clothing for an extended period. During interviews with residents, all residents stated they have not been left with wet clothing for an extended period.

For the allegation, Staff failed to provide adequate food service.

During interviews with staff, all staff stated the facility would provide adequate food. All staff stated the facility had team members who specifically worked in the kitchen and had a menu for the residents. During interviews with residents, all residents stated the facility provides adequate food and will accommodate their choice food.

For the allegation, Staff failed to meet resident's hygiene needs.

During interviews with staff, all staff stated the facility would meet residents’ hygiene needs. Staff also stated some of the residents were independent and would assist themselves with their hygiene. During interviews with residents, all residents stated staff would meet their hygiene needs.

For the allegation, Staff made inappropriate comment towards resident.

During interviews with staff, all staff stated they have not made an inappropriate comment towards a resident. All staff informed LPA they did not witness any team member make an inappropriate comment towards a resident. During interviews with residents, all residents stated no staff member has made an inappropriate comment towards them.

For the allegation, Untrained staff.

During interviews with staff, all staff stated they would receive training before assistance residents. During interviews with residents, all residents stated they would not know if someone was not trained. During record review, Licensee provided all training's staff must complete before providing care.

Based on the evidence found during the investigation, the seven (7) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

During today’s office meeting, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.
An exit interview was conducted, and this report (LIC9099) was discussed and provided to Executive Director Olevia Labeeb.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC9099 (FAS) - (06/04)

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