331800471-12-20-2023-18-AS-NBRN-CZ4R93-20240102114851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800471
Report Date: 12/20/2023
Date Signed: 12/20/2023 10:08:45 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
06/09/2021 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210609144620

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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Facility did not do a proper reassessment
Facility is not providing resident transportation
Facility not providing services paid for

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, Facility did not do a proper reassessment.

During interviews with staff, all staff stated they will notify their manager if they notice changes in their residents and will request reassessment. During interviews with residents, all residents stated they do not know what a reassessment is. All residents stated they receive exams but cannot verify if it was a reassessment.

For the allegation, Facility is not providing resident transportation.

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-20210609144620

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 the facility had a designated bus driver who will provide transportation. All staff stated that during COVID 19 there were limited transportation services for residents to prevent the spread. But they never witnessed a resident get denied transportation. During interviews with residents, all residents stated the facility provides transportation services.

For the allegation, Facility not providing services paid for

During interviews with staff, all staff indicated they provided all services to the residents. Staff also stated they provided additional assistance per resident request. During interviews with residents, all residents stated the facility provides the services they pay for.

During record review, Licensee provided all trainings staff must complete before providing care.

Based on the evidence found during the investigation, the three (3) 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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