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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426772
Report Date: 07/13/2023
Date Signed: 07/13/2023 11:40:59 AM

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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/14/2021 and conducted by Evaluator Yolanda Delgado
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211214094616
FACILITY NAME:AILIDA RETIREMENT HOMEFACILITY NUMBER:
336426772
ADMINISTRATOR:ANNALISA OLIVAN-BLANCAFLORFACILITY TYPE:
740
ADDRESS:38124 AUGUSTA DRIVETELEPHONE:
(951) 696-2482
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 4DATE:
07/13/2023
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Adela Entac, CaregiverTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff is using illegal drugs during hours of operation.
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Yolanda Delgado conducted an unannounced visit in order to deliver findings regarding the allegation listed above. LPA met with Caregiver Adela Entac and explained the purpose of the visit. Administrator Annalisa Blancaflor was called via telephone and informed.

On December 14, 2021, the Department received a complaint regarding the allegation Staff is using illegal drugs during hours of operation. It was alleged that Staff #1(S1) "pulled out a crack pipe" and started smoking in front of a visitor that S1 was meeting for a “booty call.” Information obtained from a review of records indicated S1 was not listed on the facility roster and was a new employee.

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
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 2
Control Number 18-AS-20211214094616
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: AILIDA RETIREMENT HOME
FACILITY NUMBER: 336426772
VISIT DATE: 07/13/2023
NARRATIVE
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(Continued from LIC9099)

S1 was unable to be interviewed. Information obtained from interviews conducted with three residents and two staff indicated that S1 worked at the facility for a few days and there were no reports or advisements of illegal drugs being used at the facility. Based on the information obtained, the allegation of staff using illegal drugs during hours of operation is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was provided along with LIC811-Confidential Names List.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2