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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881349
Report Date: 11/05/2024
Date Signed: 11/05/2024 01:46:25 PM

Document Has Been Signed on 11/05/2024 01:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 BELAGOFACILITY NUMBER:
331881349
ADMINISTRATOR/
DIRECTOR:
TAYLOR, KAMESHIFACILITY TYPE:
740
ADDRESS:27900 BRODIAEA AVENUETELEPHONE:
(951) 379-0100
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 125CENSUS: 90DATE:
11/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:13 AM
MET WITH:Anna Martinez, Memory Care DirectorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit at the facility to follow up on alleged thefts involving residents in care. The LPA met with Memory Care Director, Anna Martinez, and informed her of the purpose for the visit. Several reports were received by the Department, from the facility, regarding thefts of resident's property and valuables. One alleged theft involved Resident One (R1), who had a withdrawal of funds from their bank account in the amount of $1,000.00. According to a Report of Suspected Dependent Adult/Elder Abuse, R2's family member called the facility to report the resident loaned a staff member $100.00; however, after a review of bank records it was later found the check, dated 09/27/2024, was in the amount of $1,000.00. It was further alleged in the report that, R1 reported they deliberately placed $200 in a chest in their bedroom in front of the same staff member and later found the money was gone. According to the report, the staff member involved was Staff One (S1). A second report of alleged theft involved Resident Two (R2), whose bank card went missing and numerous unauthorized transactions totaling up to $8,000 being discovered. According to a Report of Suspected Dependent Adult/Elder Abuse, one purchase was made on 10/11/2024 at a beauty supply business. The business confirmed the identity of the individual who made the transaction, later identified as S1. According to a Notice to Employee as to Change in Relationship report, S1 was laid off/discharged on 10/14/2024. LPA made attempts at reaching S1 to obtain the staff member's statement; however, the attempts were unsuccessful. As of this date, R1 and R2 were not available for an interview. According to one staff interview, the incidences have been reported to law enforcement. Incident report numbers were obtained from the facility. The staff interview also revealed, as of two (2) weeks ago, that staff names have been assigned to their key fobs in order to show who last entered a resident's bedroom. It was further reported that staff, residents, and family members were notified in writing, that gifts and/or loans are not to be given to staff members of the facility. Additional time is required, prior to the closure of the investigation, in order to obtain further information. This report was reviewed with the Memory Care Director and a copy was provided. (NOTE: LPA was off the premises from 12:00 PM - 12:30 PM. Administrator, Brooke Abrego-Huerta, was unavailable for the LPA's visit.)
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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