331800471-3-5-2025-56-AS-KCLS-DF5LMG-20250326085239

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800471
Report Date: 03/05/2025
Date Signed: 03/05/2025 01:53:37 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
08/03/2022 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220803152333

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:	0	CENSUS: 158	DATE:	03/05/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Marc Pacia, Executive Director		TIME COMPLETED:	02:01 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

The Executive Director is verbally aggressive toward residents.

Bedridden residents requiring wound care are not being put on hospice.

The facility does not have enough staff to meet resident care needs.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to conclude a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Pacia and explained the elements of the complaint.

Allegation #1: LPA Prieto interviewed resident #1 (R1) and residents R2 through R13. None of the residents stated that the Executive Director had spoken aggressively towards them. Additionally, staff members S1 through S4 were interviewed, and none reported witnessing the Executive staff being verbally aggressive towards residents.

Allegation #2: The complaint alleges that residents who are either bedridden or receiving wound care are not able to be placed on hospice due to the facility being at capacity (30). However, Wellness staff and the Executive Director confirmed that the facility currently has two residents (R14 and R15) on hospice.

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: 03/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 56-AS-20220803152333

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	FACILITY NUMBER: 331800471
	VISIT DATE: 03/05/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation #3: LPA Prieto obtained the facility staff roster, which revealed that the facility is sufficiently staffed in the areas of kitchen/culinary staff, Wellness staff, and housekeeping.

Based on the information obtained, there is not enough evidence to support the allegations that the Executive Director is verbally aggressive toward residents, that bedridden residents requiring wound care are not being put on hospice, or that the facility lacks adequate staff to meet resident care needs. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Pacia, and a copy was left with the facility.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2