331881349-9-11-2025-18-AS-JDHS-DLNKKM-20250919075831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881349
Report Date: 09/05/2025
Date Signed: 09/11/2025 02:57:12 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/02/2025 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20250402160033

FACILITY NAME:	MANZANITA VILLAGE AT RANCHO BELAGO		FACILITY NUMBER:	331881349
ADMINISTRATOR:	TAYLOR, KAMESHI		FACILITY TYPE:	740
ADDRESS:	27900 BRODIAEA AVENUE		TELEPHONE:	(951) 379-0100
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	125	CENSUS: 121	DATE:	09/05/2025
		UNANNOUNCED	TIME BEGAN:	03:18 PM
MET WITH:	ADMINISTRATOR, BROOKE HUERTA		TIME COMPLETED:	04:22 PM

ALLEGATION(S):

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Facility did not administer medication as prescribed

INVESTIGATION FINDINGS:

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THIS DOCUMENT WAS AMENDED
On September 11, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced at the facility and met with the Licensee, Brooke Huerta. LPA explained the reason for the visit was to provide findings for the complaint investigation. During the investigation, LPA conducted interviews, record reviews, and made observations pertaining to the listed allegation.

On April 02, 2025, Community Care Licensing received a complaint alleging facility staff did not administer medication as prescribed. It was reported that once Resident #1 relocated from the facility, R1 was given 13 unopen boxes of eye drops, causing concern that the medication was not being distributed as described. Information obtained from interview with Licensee, Brooke Huerta, denied the allegation that R1 was not being prescribed their medication.

It was reported that the medication was provided in singular doses. Licensee indicated that R1 did not miss any prescriptions, which would be revealed on the logs. Information obtained from additional staff members indicated that the medicine was provided individually and that is why it appeared that R1 had a surplus of medication. Information received from interviews with additional residents indicated there were no concerns about how the staff administer their prescribed medications. Information obtained from interviews with additional witness confirmed R1’s prescription was provided in a larger quantity and the medication for each eye was in a separate box.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

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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Control Number 18-AS-20250402160033

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MANZANITA VILLAGE AT RANCHO BELAGO	FACILITY NUMBER: 331881349
	VISIT DATE: 09/05/2025

NARRATIVE

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LPA’s review of the records, including R1’s centrally stored medication record, medication record at the time of discharge, and discontinued medications list, verified the information provided through interviews. LPA’s review of the records confirmed there was no documentation recording that R1 missed their medication.

LPA conducted a subsequent interview with additional witness and they advised that they were unaware that the medication was provided in single doses and is now confident that R1 did not miss any medication. Additional witness indicated there were no further concerns or issues. Although LPA was unable to speak with R1 to obtain additional information, there is sufficient evidence to provide that the allegation did not occur.

Based on information obtained from interviews, record reviews, observations, the evidence received pertaining to the allegation, facility did not administer medication as prescribed, the allegation is unfounded. A finding of unfounded indicates that the allegation is false, could not have happened, or is without a reasonable basis. The agency has dismissed the complaint.

An exit interview was conducted. A copy of this report was discussed and given to the Licensee, Brooke Huerta.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

LIC9099 (FAS) - (06/04)

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