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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881233
Report Date: 06/16/2025
Date Signed: 06/16/2025 03:48:40 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
06/13/2025 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250613080344
FACILITY NAME:ANNACARE2 LLCFACILITY NUMBER:
331881233
ADMINISTRATOR:BLANCAFLOR, ANNALISAFACILITY TYPE:
740
ADDRESS:20846 SUNDROPS LANETELEPHONE:
(951) 399-0363
CITY:WILDOMARSTATE: CAZIP CODE:
92592
CAPACITY:6CENSUS: 5DATE:
06/16/2025
UNANNOUNCEDTIME BEGAN:
01:58 PM
MET WITH:Annalisa Blancaflor, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Licensee failed to provide resident's records to authorized party.
INVESTIGATION FINDINGS:
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On 06/16/25 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation for the allegation noted above. LPA met with Administrator Annalisa Blancaflor, and explained the elements of the allegation. The allegation was investigated and, the investigation consisted of observations, interviews and records review.

On 06/13/25 Community Care Licensing received a complaint alleging that the Licensee failed to provide Resident's #1 (R1) records to authorized party. It was further alleged that there were ten (10) attempts made to obtain R1s records. The initial request was made on 04/30/25, and subsequent request on 05/09/25, 05/22/25, 05/23/25, 05/27/25, 05/28/25, 5/30/25, 06/03/25, 06/04/25 and 06/06/25. Per an interview with administrator Annalisa Blancaflor who confirmed that she was aware of the multiple requests, however Blancaflor did not comply. Due to never having a request from an authorized representative, and being unsure of what to do. LPA reminded Blancaflor to contact the department or review the evaluator manual should she require further guidance. Based on interviews the allegation of licensee failed to provide resident
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
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 3
Control Number 18-AS-20250613080344
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: ANNACARE2 LLC
FACILITY NUMBER: 331881233
VISIT DATE: 06/16/2025
NARRATIVE
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records to authorized party is substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted and a copy of this report, 9099C, 9099D, appeal rights were reviewed and provided to Annalisa Blancaflor, Administrator.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250613080344
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: ANNACARE2 LLC
FACILITY NUMBER: 331881233
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2025
Section Cited
CCR
87506(c)(1)
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Resident Records (c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make
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There is no POC due at this time. R1s file was surrendered when requested. Per the administrator R1s full file was copied and provided to LPA during today's (6/16/25) visit.
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 available confidential information only upon the resident's written consent or that of his designated representative. This requirement is not met as evidenced by: the licensee did not provide R1s records, which posed a potential health, safety and personal rights risk to persons in care.
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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.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3