335530032-6-12-2023-56-AS-KCLS-CTM2UW-20230710174257

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 06/12/2023
Date Signed: 06/12/2023 04:45:51 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
06/09/2023 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230609165004

FACILITY NAME:	VILLA DE ANZA		FACILITY NUMBER:	335530032
ADMINISTRATOR:	KATHERINE A. TREVINO		FACILITY TYPE:	740
ADDRESS:	5881 EL PALOMINO DRIVE		TELEPHONE:	(951) 683-3333
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY:	197	CENSUS: 113	DATE:	06/12/2023
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Patrick McAdoo Morton, Executive Director		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Facility unlawfully evicted resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding an allegation that the facility unlawfully evicted resident. LPA Prieto met with Patrick McAdoo Morton and discussed the elements of the complaint. Director Morton stated that resident #1 (R1), in question, had not been evicted and continues to be hospital since being transferred for treatment on 06/07/2023. Documentation was obtained relating to the transfer. LPA toured R1's room to see R1 continues to have their belongings.

Based on the information obtained there is not enough evidence that the facility unlawfully evicted resident. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Director Morton and a copy was left with the facility.

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: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

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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