<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800223
Report Date: 08/03/2026
Date Signed: 08/03/2026 02:50:59 PM

Substantiated


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
07/23/2026 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20260723142606
FACILITY NAME:YORKSHIRE VILLAGEFACILITY NUMBER:
331800223
ADMINISTRATOR:TERESA MAPILISFACILITY TYPE:
740
ADDRESS:26933 CORNELL STTELEPHONE:
(951) 658-1068
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:100CENSUS: 86DATE:
08/03/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Executive Director, Teresa MapilisTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Due to lack of supervision resident sustained a fall resulting in a minor injury
Staff did not meet resident's nutritional needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/3/2026, Licensing Program Analyst (LPA) Valerie Flores and Licensing Program Manager (LPM) Carolyn Tuba conducted an unannounced visit to the facility for the purpose of delivering the complaint findings into the allegations listed above. LPA Flores met with Executive Director, Teresa Mapilis, and explained the purpose of the visit. The investigation is summarized as follows:

On 7/23/2026, Community Care Licensing (CCL) received a complaint alleging staff did not meet Resident #1’s (R1) nutritional needs by only providing R1 cheerios to eat. Additional information received reported that staff are not following R1’s restricted diet, reporting that R1 was observed eating pizza and a trix yogurt. CCL conducted an unannounced visit on 7/24/2026 where R1 was observed sitting in the dining room with their plate place in front of R1. LPA approached R1 and observe a half-cut hamburger, French fries, trix yogurt, and a pickle spear on R1’s plate.

(Continue to LIC9099)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2026
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
Control Number 18-AS-20260723142606
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: YORKSHIRE VILLAGE
FACILITY NUMBER: 331800223
VISIT DATE: 08/03/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Continuation from LIC9099)

Per R1’s care plan date 10/30/2025, R1 requires a No-Concentrated-Sweets (NCS) diet, needs help cutting food, and verbal prompts. A re-appraisal conducted on 7/13/2026 details that R1 requires a special diet which entails NCS, Mechanical soft, No-Added-Salt (NAS), chopped or cut up upon minced and moist with extra gravy or sauces. Staff #1 (S1) interview confirmed that the appraisal conducted on 7/13/2026 is current and accurate. S1 believes that the meal was not cut up for R1 out of error.

Additional information received alleges that due to lack of supervision, resident sustained a fall resulting in a minor injury. Video surveillance obtained captures R1 in the dining room at the exit that leads to the secured courtyard. R1 is observed attempting to open the door. Staff #1 (S1) was observed briefly looking towards the direction of R1 and continued to walk towards the south wing of the building. Resident #2 (R2) is observed approaching the door from the outside and opening the door for R1. R1 then wheeled themselves towards the outdoor ramp and is observed wheeling down the ramp as a quick speed. R1’s wheelchair wheel was observed to hit the pole of the outside canopy causing R1’s body to jerk forward resulting to R1 falling out of their wheelchair. In the video, R1 did not appear to make an attempt to slow down. The care plan dated 10/23/2025 reports that R1 requires full assistance in mobility including assistance with observation and fall management, escorts to meal, escorts to activities with the use of a wheelchair or hospital bed. According to the care plan, staff will meet R1’s needs by ensuring safe ambulation, mobility, and repositioning. R1’s appraisal conducted on 7/13/2026 continues to note R1 requiring max assistance in mobility. Staff interviews report that max assistance means that staff need to physically assist a resident with mobility which includes maneuvering the wheelchair.

Therefore, based on observations, records review, and interview, the allegation of staff did not meet residents nutritional needs and due to lack of supervision resident sustained a fall resulting in a minor injury are deemed substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid as the preponderance of the evidence standard has been met. A citation will be issued in accordance with Title 22, Division 6, Regulations.
An exit interview was conducted, and a copy of this report was provided, along with a copy of LIC9099C, LIC9099D, and Appeal Rights were provided to Executive Director, Teresa Mapilis. The report was signed by Wellness Coordinator, Marielle Figueroa.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-AS-20260723142606
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: YORKSHIRE VILLAGE
FACILITY NUMBER: 331800223
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/17/2026
Section Cited
CCR
87555(b)(7)
1
2
3
4
5
6
7
(b) The following food service requirements shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement was not met with evidence by: Resident #1 (R1) specialized diet was not followed which poses a potential health and safety risk to the
1
2
3
4
5
6
7
Per Executive Director, wellness and dietary staff will participate in an in-service training regarding specialized diets and following residents care plans. The training completion will outline what was covered and who was in attendance. Proof of completion will be submitted to LPA by close of business
8
9
10
11
12
13
14
... resident in care.
8
9
10
11
12
13
14
Type B
08/17/2026
Section Cited
CCR
87468.2(a)(4)
1
2
3
4
5
6
7
(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by
1
2
3
4
5
6
7
Per Welless Director, an in-service training will be held in regard to providing appropriate coverage to meet all residents needs. Proof of training will outline who was in attendance and was was covered will be provided to LPA by close of business on 8/17/2026.
8
9
10
11
12
13
14
... staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met with evidence by: R1 was not provided additional supervision while ambulating in their assistive device resulting to R1's fall which poses a health and safety risk to the resident in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3