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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603683
Report Date: 08/09/2026
Date Signed: 08/09/2026 02:24:32 PM

Unfounded


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
02/17/2023 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230217085412
FACILITY NAME:BREEZE HILL CAREFACILITY NUMBER:
374603683
ADMINISTRATOR:SMILJA MILOSAVLJEVICFACILITY TYPE:
740
ADDRESS:799 MARSOPA DRIVETELEPHONE:
(760) 631-0267
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY:6CENSUS: 6DATE:
08/09/2026
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Staff, Evangeline BartolazoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not complete an initial personal property inventory when resident entered the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility in order to conduct an investigation into the allegation above. LPA met with the Staff, Evangeline Bartolazo, who was informed of the purpose of the visit.

LPA conducted interviews, documented observations and collected documentation for the resident. Regarding allegation " Staff did not complete an initial personal property inventory when resident entered the facility. " It was alleged that the facility staff failed to complete a personal property inventory form for the resident. The LPA reviewed the resident's file and found that the facility did complete this form and obtained a copy of this. When facility staff was interviewed on what belongings the resident came to the facility with, the staff responses were consistent with the personal property form that was filled out. This agency has investigated the complaint and found that the allegation unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with this report was reviewed and provided to them.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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