331800471-8-5-2021-18-AS-EMAN-CAYW3U-20220124155630

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800471
Report Date: 08/05/2021
Date Signed: 08/05/2021 09:42:12 AM

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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2021 and conducted by Evaluator Jennifer Semin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210729141800

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:	144	CENSUS: 93	DATE:	08/05/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Taylor Collins		TIME COMPLETED:	09:55 AM

ALLEGATION(S):

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Facility does not have enough food for residents in care
Staff are not serving quantity of food necessary to meet the needs of the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Semin conducted an unannounced visit to deliver the findings for the above complaint allegations. LPA met with administrator Taylor Collins.
Regarding the allegation " Facility does not have enough food for residents in care.” LPA observed a sufficient amount of food, 2 days perishable and 7 days nonperishable, for the residents in care. Administrator stated food service truck delivers food twice a week.
Regarding the allegation “Staff are not serving quantity of food necessary to meet the needs of the residents.” Interviews with staff and residents revealed although the portions are small, staff will provide second helpings or an alternative supplement if requested.
Based on interviews and observations, the above allegations are found to be UNSUBSTANTIATED. 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, therefore these allegations are unsubstantiated at this time.
An exit interview was conducted where this report was discussed and provided to Ms. Collins.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Jennifer Semin	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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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