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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603847
Report Date: 08/22/2025
Date Signed: 08/22/2025 09:14:39 AM

Unsubstantiated


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
11/08/2023 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20231108114730
FACILITY NAME:VILLA VERDE HOMEFACILITY NUMBER:
374603847
ADMINISTRATOR:ANDRES, GREGORYFACILITY TYPE:
734
ADDRESS:2286 VILLA VERDE ROADTELEPHONE:
(760) 317-1644
CITY:ESCONDIDOSTATE: CAZIP CODE:
92029
CAPACITY:5CENSUS: 5DATE:
08/22/2025
UNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Kaitlynn Buck, Lead RNTIME COMPLETED:
09:20 AM
ALLEGATION(S):
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Facility staff caused injury to client.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA met with Lead LVN Kaitlynn Buck the administrator Gregory Andres was available via telephone, explained the reason for the visit.

On 11/08/2023, the Riverside Adult and Senior Care Regional Office (RO) received a complaint alleging Villa Verde Home facility staff moved Client #1 (C1) during the early morning hours of 11/08/2023 and heard a “pop.” C1 was immediately transferred to the hospital and was found to have a fracture at C1’s right femur. The hospital notes indicate the emergency room doctor felt C1’s injury was “inconsistent” with the “story provided by staff at the Villa Verde Home, but no particular suspected abuser is identified.”

The Escondido Police Department was contacted and advised that the case was not being pursued. A review of C1’s Individual Program Plan (IPP) dated 12/28/2021 noted C1 has several medical conditions, including cerebral palsy, profound intellectual disability, and epilepsy. C1 requires a high
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
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 2
Control Number 18-AS-20231108114730
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: VILLA VERDE HOME
FACILITY NUMBER: 374603847
VISIT DATE: 08/22/2025
NARRATIVE
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amount of aid and supervision, including continence care and assistance with ADLs (Activities of Daily Living). C1 also exhibits self-injurious behavior on average once a month and disruptive behavior on average once a week. C1 is non-verbal. C1’s records also noted C1 had a diagnosis of osteoporosis and was at a high risk for fracture. C1 was admitted to the facility on 06/28/2018. A review of the Unusual Incident/Injury Report dated 11/08/2023 documents on 11/08/2023 at 12:15am two staff were changing C1’s adult brief and cleaning C1. Staff #1 (S1) moved C1’s right leg and heard a “pop” at C1’s right knee. C1 was noted as showing resistance during the incident. The facility nurse assessed C1’s knee and observed swelling and noticed C1 grimacing. C1 was given Tylenol and taken to the hospital. A distal femur fracture was diagnosed, and C1 was issued a splint. C1 then returned to Villa Verde Home facility. The staff involved were noted as S1, Staff #2 (S2) and the facility LVN. The facility’s actions taken was noted as “mandatory in-service and retraining on changing, showering, and lifting.”
The hospital medical records were reviewed. The records noted the emergency room (ER) visit on 11/08/2023 at 1:49am with a Chief Complaint of being brought in was staff was moving patient when they heard the right knee pop and patient appeared to be in pain. The notes indicate C1 is non-verbal at baseline and bedbound. The ER physician notes state the chronicity of the injury is unclear, but given C1’s bedbound status, it could be from a minor trauma although typically this is a higher mechanism injury. Later in the medical records, the X-rays and CT scans results noted the injury appears to be a “true accident.” A splint was applied and C1 was discharged back to the facility “safe to return home” the same day.
The Department’s investigation did not provide sufficient evidence and information to substantiate an allegation of physical abuse against Villa Verde Home staff pertaining to the fracture sustained by C1 on 11/08/2023. C1’s placement agency was also contacted, who confirmed the incident was reviewed by including interviews by a consulting Registered Nurse, as well as by another California Department Agency. No abuse or neglect was substantiated. C1’s primary physician was interviewed and the physician denied any concern for abuse or neglect, attributing the primary reason for the fracture was the medical fragility of the client. The Police Department also responded to the incident and declined to pursue the matter for any criminal violations. The information obtained during the Department’s investigation did not sufficiently support the allegation. While C1 did sustain a fracture, the investigation did not provide sufficient evidence to substantiate that physical abuse led to the injury. Therefore, the allegation is deemed Unsubstantiated at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. Exit interview conducted, copy of this report was reviewed and provided to Kaitlynn Buck.
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC9099 (FAS) - (06/04)
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