331800471-12-20-2023-18-AS-NBRN-CZ4QWU-20240102113232

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800471
Report Date: 12/20/2023
Date Signed: 12/20/2023 10:32:24 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
07/16/2021 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210716151500

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 Labee		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff are not responding to residents call buttons timely do to insufficient staffing
Residents are left on the toilet for extended periods of time due to insufficient staffing
Residents have to wait an extended period of time for meals due to insufficient staffing
Resident(s) medications are found on the ground
Residents are left in soiled diapers
Medications are not being given as needed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico met with Executive Director Olevia Labee 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, Staff are not responding to residents call buttons timely do to insufficient staffing.

During interviews with staff, all staff indicated they would respond to resident’s call buttons on time. During interviews with residents, all residents stated they receive assistance when they press their call button and have not notice if there’s insufficient staff.

For the allegation, Residents are left on the toilet for extended periods of time due to insufficient staffing.

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-20210716151500

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 have not left a resident on the toilet for extended periods of time due to insufficient staffing. During interviews with residents, all residents stated they have never been left on the toilet for extended periods of time due to insufficient staff.

For the allegation, Residents have to wait an extended period of time for meals due to insufficient staffing.

During interviews with staff, all staff stated residents did not wait for an extended period of time for meals. All staff stated the facility had enough kitchen staff who will prepare meals and assist during mealtimes. During interviews with residents, all residents stated they have received their meals on time.

For the allegation, Resident(s) medications are found on the ground.

During interviews with staff, all staff stated they have not witnessed medication on the floor. During interviews with residents. All residents stated they have not witnessed medication on the floor.

For the allegation, Residents are left in soiled diapers.

During interviews with staff, all staff stated they have not left residents with soiled diapers. During interviews with residents, all residents stated staff have not left them with soiled diapers.

For the allegation, Medications are not being given as needed.

During interviews with staff, all staff stated med-tech receive alerts when medications are due and when needed. During interview with residents. All residents stated they received their medications when needed.

During record review, Licensee provided require training's all staff members must complete before providing care.

Based on the evidence found during the investigation, the six (6) 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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