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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881349
Report Date: 10/21/2025
Date Signed: 10/21/2025 04:03:40 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
04/12/2023 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20230412124717
FACILITY NAME:MANZANITA VILLAGE AT RANCHO BELAGOFACILITY NUMBER:
331881349
ADMINISTRATOR:TAYLOR, KAMESHIFACILITY TYPE:
740
ADDRESS:27900 BRODIAEA AVENUETELEPHONE:
(951) 379-0100
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:125CENSUS: DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Executive Director, Brooke HuertaTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff did not respond to the resident’s calls for assistance in a timely manner
INVESTIGATION FINDINGS:
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On 10/21/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering an investigative finding into the allegation listed above. LPA met with Executive Director, Brooke Huerta, and explained to Anna the purpose of the visit. The investigation consisted of interviews and records review.

Information received alleged that facility staff did not respond to residents calls for assistance in a timely manner. Records review conducted of the facility’s signaling system logged from April 11, 2023 to April 18, 2023 detailed numerous incidents of residents waiting approximately 20 minutes to 65 minutes until care staff arrived to assist the resident. Interviews conducted with residents divulged that the facility was experiencing a shortage of staff resulting in a delay of when residents would receive assistance.

(Continue to LIC9099C...)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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 5
Control Number 18-AS-20230412124717
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MANZANITA VILLAGE AT RANCHO BELAGO
FACILITY NUMBER: 331881349
VISIT DATE: 10/21/2025
NARRATIVE
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(Continuation from LIC9099)

During an interview conducted with Resident #1 (R1), R1 reported waiting an hour until staff arrived to assist R1. A record review conducted for the signal system revealed that on 4/18/2023, R1 waited 65 minutes for care staff to arrive for assistance. Interviews conducted with (5) residents corroborated waiting long periods of time to receive assistance once a pendant was activated.

Based on records review and interviews, the preponderance of evidence standard has been met. Therefore, the allegation of staff did not respond to residents call for assistance in a timely manner is deemed substantiated.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulations Title 22 is being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of the LIC9099, LIC 9099D, and appeal rights were reviewed and provided to Executive Director, Brooke Huerta.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
04/12/2023 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20230412124717

FACILITY NAME:MANZANITA VILLAGE AT RANCHO BELAGOFACILITY NUMBER:
331881349
ADMINISTRATOR:TAYLOR, KAMESHIFACILITY TYPE:
740
ADDRESS:27900 BRODIAEA AVENUETELEPHONE:
(951) 379-0100
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:125CENSUS: DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Executive Director, Brooke HuertaTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff do not meet the needs of the resident’s religious dietary preferences
INVESTIGATION FINDINGS:
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On 10/21/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering an investigative finding into the allegation listed above. LPA met with Executive Director, Brooke Huerta, and explained to Anna the purpose of the visit. The investigation consisted of interviews and records review.
Information received alleged staff did not meet the needs of Resident #1 (R1) and Resident #2 (R2) religious dietary preferences. Interviews conducted with (4) four out of (5) five residents with dietary restriction reported facility staff did not follow their dietary restriction despite efforts to remind staff of their dietary restrictions. Resident #2 (R2) was unavailable to be interviewed despite multiple efforts of LPA attempting to speak with R2. An interview with Resident #3 (R3) reported that they do not have a dietary restriction but confirmed the facility provided meals often containing pork items and food that are not of nutritional value.

(Continue to LIC9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20230412124717
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MANZANITA VILLAGE AT RANCHO BELAGO
FACILITY NUMBER: 331881349
VISIT DATE: 10/21/2025
NARRATIVE
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(Continuation from LIC9099)

Interviews conducted with (4) four out of (6) six staff reported there being an alternative main course menu for residents with dietary restrictions which allowed residents to choose what they wanted to eat if the resident could not eat something that was served in the scheduled main course meal. Interviews with staff further reported that kitchen staff had a list of resident names and their dietary restrictions to ensure the residents needs were met. Interview with Staff #1 (S1) reports their being alternatives available to residents but not being of nutritional value. LPA attempted to conduct an interview with Staff #2 (S2) who declined LPA’s interview request. Records review conducted of the facility’s weekly menu documents main course meals to have pork products multiple times a week for every mealtime (i.e. breakfast, lunch, and dinner) but offered alternatives to substitute a main course item. Therefore, the allegation of staff do not meet the needs of the resident’s religious dietary preferences is deemed unsubstantiated.

A finding that is deemed unsubstantiated means that although the allegation may have occurred, there is not enough evidence to prove the violation did or did not take place.

Exit interview conducted and copy of report provided Executive Director, Brooke Huerta.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20230412124717
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MANZANITA VILLAGE AT RANCHO BELAGO
FACILITY NUMBER: 331881349
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2025
Section Cited
CCR
87468.2(a)(4)
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(a) In addition to the rights listed in Section 87468.1... residents in privately operated residential care facilities for the elderly shall have all of the following personal rights (4) To care, supervision, and services that meet individual needs... This requirement was not met with evidence by:
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Executive Director (ED) Brooke Huerta agreed to do an in-service training with care staff on how to answer pendant system and cover what is a "timely manner" with care staff. ED agreed to conduct unannounced random pendant activations with staff to ensure calls are being cleared within a
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Through interviews and records review staff did not respond to (5) five out of (5) five residents within a timely manner resulting to residents waiting between an average of 30 minutes to a hour for staff assistance which is a potential health and safety risk to residents in care.
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timely manner. Plan of Correction will be emailed to LPA by Closed of Business on 11/04/2025.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5