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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800223
Report Date: 09/22/2026
Date Signed: 09/22/2026 12:32:55 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: 82DATE:
09/22/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Business Office Manager Nicole AnguianoTIME COMPLETED:
12:46 PM
ALLEGATION(S):
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Staff did not provide medication in a timely manner
INVESTIGATION FINDINGS:
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On 9/22/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering the complaint findings into the allegation listed above. LPA Flores with Medication Technician Manager Bianey Sandoval and explained the purpose of the visit. The investigation is summarized as follows:

On 7/23/2026, Community Care Licensing (CCL) received information alleging staff did not provide medication to Resident #1 (R1) in a timely manner. A review of R1’s Medication Administration Record (MAR) confirmed that R1 did not receive Medication #1 (M1) at 8:00PM on 7/16/2026 with a comment reporting that R1 did not receive the medication due to hospitalization. The facility’s internal incident notes report that R1 returned back into the community at 8:30PM. An interview with Staff #1 (S1) reports that the facility has a verbal policy where medication may be passed one hour before and/or after the set time on the MAR.

(Continue LIC9099C...)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2026
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: 09/22/2026
NARRATIVE
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(Continuation from LIC9099)

S1 reports that R1 did not receive their medication as it was administered to R1 while R1 was at the hospital. S1 stated that if the medication was administered at the hospital, the hospital would notate to continue at home medications. An interview with Staff #2 (S2) confirmed that staff did not contact the hospital to confirm if M1 was provided to R1 while at the hospital. Hospital records obtained reported that R1 was released back into the facility with instructions for glucose monitoring. In addition, an assessment summary dated 7/16/2026 reports that R1 did not receive any medication during the visit. Hospital reports that they informed R1 of discharge instructions and was release back to transportation services.

Therefore, the allegation of staff did not provide medication in a timely manner is deemed substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulations Title 22 is being cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of the LIC9099, LIC9099C, LIC9099D, and appeal rights were reviewed and provided to Medication Technician Manager Bianey Sandoval.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 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: 09/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2026
Section Cited
CCR
87465(c)(2)
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(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff ... shall be permitted to assist the resident with self-administration, provided all
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An in-service training will be held with Medication Technicians pertaining to communications with the hospitals and/or care providing pertaining to discharge instructions. Proof of training will be submitted to LPA via email by close of business 10/6/2026 with a list of who was in ..
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...of the following requirements are met: (2) ...the medication is given according to the physician's directions. This requirement was not met with evidence by: R1 was not provided their medication during its allotted time which poses a potential health and safety risk to the resident in care.
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attendance.
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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: 09/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3