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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881706
Report Date: 10/12/2026
Date Signed: 10/12/2026 01:49:39 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
10/05/2026 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20261005114434
FACILITY NAME:VILLA ANNEFACILITY NUMBER:
331881706
ADMINISTRATOR:FIGUEROS, STEPHANIEFACILITY TYPE:
740
ADDRESS:3011 Nova Scotia DRTELEPHONE:
(951) 784-1066
CITY:RiversideSTATE: CAZIP CODE:
92506
CAPACITY:6CENSUS: 6DATE:
10/12/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator Stephanie FiguerosTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Night staff are not available to assist in caring for residents in a timely manner during an emergency
INVESTIGATION FINDINGS:
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On 10/12/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of launching the complaint investigation into the allegation listed above. LPA Flores met with Administrator Stephanie Figueros and explained the purpose of the visit. The investigation consisted of interviews and is summarized as follows:

On 10/5/2026, Community Care Licensing received information alleging night staff were not available to assist in caring for Resident #1 (R1) in a timely manner after R1 experienced an unwitnessed fall. An interview with R1 reports that turned over while sleeping and fell out of their bed and onto the floor. R1 called out for staff assistance but no one arrived to assist until staff woke up three hours later. R1 reports that they are non-ambulatory and attempted to crawl out of the bedroom for assistance but was not able to make it out of the bedroom.

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

DATE: 10/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2026
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 7
Control Number 18-AS-20261005114434
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 ANNE
FACILITY NUMBER: 331881706
VISIT DATE: 10/12/2026
NARRATIVE
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(Continuation from LIC9099)

Interviews with staff report that they conduct visual checks of residents prior to their bedtime, at 10:00 PM, and will not wake up to check the residents until 5:00 AM. Staff report that they may occasionally check on the residents if they wake up in the night to use the bathroom, otherwise, they will not check. An interview with Staff #1 (S1) reports that when they woke up at 5:00AM to begin their workday, they went around to do a visual check of the residents. S1 reports observing R1 on the floor near their closet and are unsure how and when R1 had fallen.

Therefore, the allegation of night staff are not available to assist in caring for residents in a timely manner during an emergency is 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. California Code of Regulations Title 22 is being cited on the attached LIC9099D.

An exit interview was conducted, and a copy of this report was provided to Administrator.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 18-AS-20261005114434
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 ANNE
FACILITY NUMBER: 331881706
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/26/2026
Section Cited
HSC
1569.2(c)
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(c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. This requirement was not met...
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Administrator stated they would provided additional health and safety checks during the night time but will staff appropriate times with the live-in caregivers. An outline of what was discussed and how often safety checks will be provided to LPA along with the persons in attendance to the meeting.
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with evidence by: Due to lack of care and supervision, Resident #1 (R1) was left on the floor for a prolonged period of time after R1 experienced an unwitnessed fall which posed a potential health and safety to the resident while in care.
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Plan of Correction will be provided to LPA by Close of Business of 10/26/2026.
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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: 10/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
10/05/2026 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20261005114434

FACILITY NAME:VILLA ANNEFACILITY NUMBER:
331881706
ADMINISTRATOR:FIGUEROS, STEPHANIEFACILITY TYPE:
740
ADDRESS:3011 Nova Scotia DRTELEPHONE:
(951) 784-1066
CITY:RiversideSTATE:CAZIP CODE:
92506
CAPACITY:6CENSUS: 6DATE:
10/12/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator Stephanie FiguerosTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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9
Staff handled resident in a rough manner
Staff mismanaged resident's medication
INVESTIGATION FINDINGS:
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On 10/12/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of launching the complaint investigation into the allegations listed above. LPA Flores met with Administrator Stephanie Figueros and explained the purpose of the visit. The investigation consisted of interviews and is summarized as follows:

On 10/5/2026, Community Care Licensing (CCL) received information alleging staff handled Resident #1 (R1) in a rough manner. Interview with R1 reports that a male staff pulled on their arm aggressively while assisting R1 into a shower chair. R1 reports that they advised this unknown male staff that they hurt R1 but the male staff did not comprehend English. Additional resident interviews report that they have never experienced a time when staff have ever handled them in a rough manner nor have they observed staff handle any residents in a rough manner.

(Continue to LIC9099AC1)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 18-AS-20261005114434
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 ANNE
FACILITY NUMBER: 331881706
VISIT DATE: 10/12/2026
NARRATIVE
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(Continuation from LIC9099A1)

Interviews with staff report that they have never handled residents in a rough manner nor have they observed other staff handle any residents in a rough manner.

Additional information alleged staff mismanaged R1’s medication by providing R1’s medication for Medication #1 (M1) every Thursday, instead of every Monday. An interview with R1 reports that they are unsure if they were receiving M1 as followed by the physicians order. R1 explained that medications were provided to the resident in a separate container and was not able to identify what medication was which. In addition, R1 stated that they did not count the medication to see if there was an additional medication on a certain day. Interviews with staff report that M1 was provided to R1 every Monday per the physicians instructions. LPA received photos of the physicians orders. The physicians order revealed that the patient may choose a day of the week that M1 may be taken that best fits their schedule. The facility did not maintain a Medication Administration Record to confirm when the medication was provided to R1.

Therefore, the allegations of staff handled resident in a rough manner and staff mismanaged resident's medication is deemed unsubstantiated. A finding of UNSUBSTANTIATED means that the preponderance of evidence standard has not been met.

An exit interview was conducted, and a copy of this report was provided to the Administrator.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
10/05/2026 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20261005114434

FACILITY NAME:VILLA ANNEFACILITY NUMBER:
331881706
ADMINISTRATOR:FIGUEROS, STEPHANIEFACILITY TYPE:
740
ADDRESS:3011 Nova Scotia DRTELEPHONE:
(951) 784-1066
CITY:RiversideSTATE:CAZIP CODE:
92506
CAPACITY:6CENSUS: 6DATE:
10/12/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator Stephanie FiguerosTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff are locking residents in their bedroom
INVESTIGATION FINDINGS:
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On 10/12/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of launching the complaint investigation into the allegation listed above. LPA Flores met with Administrator Stephanie Figueros and explained the purpose of the visit. The investigation consisted of interviews and observation which is summarized as follows:

On 10/5/2026, Community Care Licensing received information alleging staff locked Resident #1 (R1) in their bedrooms at nighttime. LPA conducted a tour of the facility and observed the bedroom doors to be equipped with a standard privacy doorknob with the locking mechanism on the inside of the bedroom door. The outside of the doorknob may be unlocked with a fingernail or flat edge tool. Interview with R1 reports that staff occasionally shut the door to prevent other residents from wandering into their room.

(Continue to LIC9099A2C)
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 18-AS-20261005114434
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 ANNE
FACILITY NUMBER: 331881706
VISIT DATE: 10/12/2026
NARRATIVE
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(Continuation from LIC9099A2)

R1 reports that they are unsure if they were ever locked in the room as they require assistance with getting out of bed. Additional resident interviews report that staff have never locked them in their bedroom and are able to open the door on their own. Staff interviews conducted denied the allegation of staff locking residents in their rooms, explaining that the resident have the ability to lock and unlock the door from the inside of the bedroom. Staff report that they do not shut the residents door unless instructed by the resident.

Therefore, the allegation of staff lock residents in their room is deemed unfounded. A finding of UNFOUNDED means that the allegation is false, could not have happened, or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided to Administrator.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 7