335530032-2-22-2023-56-AS-KCLS-CQ4RE7-20230320125705

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 02/16/2023
Date Signed: 02/22/2023 04:52:31 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
11/01/2022 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221101163800

FACILITY NAME:	VILLA DE ANZA		FACILITY NUMBER:	335530032
ADMINISTRATOR:	ESPINAL, KENNY		FACILITY TYPE:	740
ADDRESS:	5881 EL PALOMINO DRIVE		TELEPHONE:	(951) 683-3333
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY:	197	CENSUS: 92	DATE:	02/16/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Katherine Trevino,, Executive Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not provide proper notice to resident of rate increase
Facility did not assist resident with arrangement of transportation services

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to concluded a complaint investigation regarding the above-mentioned allegations. LPA Nickolas interviewed staff #1 (S1), S2 and S3 and interviews reveal that the facility does provide assistance with arrangement of transportation service and those arrangements are made in advance to assure availability for all residents. Those same interviews reveal that the client #1 (C1), asked for a same day transport. Alternate transport was offered to C1 to travel same day, but C1 refused those services. Executive Director Trevino stated letter of rate increase was placed in C1's mailbox on November 1, 2022 for a rate increase effective January 1, 2023. Interview with C1 was unsure if that letter was or was not received. C1 was aware of a rate increase on or before the required 60 day notice.
Based on the information obtained there is not enough evidence that facility did not provide proper notice to resident of rate increase and facility did not assist resident with arrangement of transportation services . Therefore, the allegations are deemed UNSUBSTANTIATED at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

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: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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 3