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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881349
Report Date: 12/17/2025
Date Signed: 12/17/2025 04:08:51 PM

Unsubstantiated


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
07/22/2025 and conducted by Evaluator Venus Mixson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250722121432
FACILITY NAME:MANZANITA VILLAGE AT RANCHO BELAGOFACILITY NUMBER:
331881349
ADMINISTRATOR:BROOKE HUERTAFACILITY TYPE:
740
ADDRESS:27900 BRODIAEA AVENUETELEPHONE:
(951) 379-0100
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:125CENSUS: 124DATE:
12/17/2025
UNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:EXECUTIVE DIRECTOR, ANNA MARTINEZTIME COMPLETED:
04:18 PM
ALLEGATION(S):
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Staff are not properly supervising a resident who is a fall risk
INVESTIGATION FINDINGS:
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On December 17, 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 July 22, 2025, Community Care Licensing received a complaint alleging staff are not properly supervising a resident who is fall risk. It was reported that Resident #1 (R1) is not being properly supervised because on July 21, 2025, the First Responders/ Emergency Services were called out twice within three hours on the same day. R1 had an unwitnessed fall, but there were no observable injuries and they did not complain of any pain. Information obtained from interview with Administrator; Brooke Huerta, indicated the facility staff are providing adequate supervision. Furthermore, Administrator specified that staff followed the emergency policy and procedures in place of an unwitnessed fall. Administrator stated that R1 is a fall risk and there is a plan in place to mitigate the number of falls. Administrator indicated that R1 requires assistance to transfer, but will try to transfer from their chair to their bed, without pressing their pendant for assistance. Information obtained from interviews with the staff indicated staff followed medical emergencies procedures for when a resident falls, which includes properly reporting and documenting the incident.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
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 2
Control Number 18-AS-20250722121432
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: 12/17/2025
NARRATIVE
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Additionally, staff stated that they followed R1’s plan to reduce falls, but R1 did not call for assistance. Additional information received from interviews indicated that staff did remain with R1 until first responders arrived. Information obtained from an interview with R1 described that they attempted to get out of bed without notifying staff that they need assistance. R1 corroborated that they refused medical care as they were not experiencing pain. R1 stated they have not experienced staff delaying assistance for unreasonable amounts of time. R1 indicated there are no concerns with how the facility staff attend to their daily needs or supervision. Information obtained from interviews with additional residents indicated they feel safe while at the facility and have no concerns about how staff attend to their daily needs. Information obtained from interviews with Additional Witness indicated R1 had an unwitnessed fall and that R1 refused to be transported for further medical evaluation. On several unannounced visits, LPA observed R1 attempting to get up out of their wheelchair, prior to calling staff for assistance. A review of the records, including the facility’s policy and procedure regarding reporting, corroborated the information obtained. An additional review of the records, including R1’s needs and service plan, confirmed R1 is a fall risk and R1 is to call for assistance prior to transferring from their wheelchair.

Based on information obtained from interviews, record reviews, and observations, the evidence received pertaining to the allegation that staff are not properly supervising a resident who is a fall risk has been deemed unsubstantiated. An unsubstantiated allegation means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted. A copy of this report was discussed and given to the Administrator, Brooke Huerta.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2