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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881349
Report Date: 01/29/2026
Date Signed: 01/29/2026 03:02:44 PM

Unsubstantiated


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
03/27/2025 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 18-AS-20250327112938
FACILITY NAME:MANZANITA VILLAGE AT RANCHO BELAGOFACILITY NUMBER:
331881349
ADMINISTRATOR:TAYLOR, KAMESHIFACILITY TYPE:
740
ADDRESS:27900 BRODIAEA AVENUETELEPHONE:
(951) 379-0100
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:150CENSUS: 122DATE:
01/29/2026
UNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Cristina Miller and Anna MartinezTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility Staff neglected the needs of residents in care.
INVESTIGATION FINDINGS:
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On January 29, 2026, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegations and to deliver findings. The Department was met by Christina Miller and Anna Martinez, Executive Director and Assistant Executive Director and the purpose of the visit was explained.
Investigation consisted of the following:
On 4/2/25, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegation mentioned above. During the visit, 3 staff interviews and 3 resident interviews were conducted. It was determined that the complaint required further investigation. On 4/25/25 and 9/11/24, subsequent visits were made and during that visit, 5 resident and 3 witness interviews were conducted. However, no findings were rendered.
On January 28, 2026, the Department requested and obtain the following documents via email: Resident rights training (dated 3/27/25), Incontinent care training (dated 3/6/25), Service plan, physician’s report, and pre-placement appraisals for Residents (R1-R5), Incident/death report for R3 (dated 3/25/25)
The department conducted interviews with Assistant Administrator (A2), and 4 staff (S1-S4).
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
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 3
Control Number 18-AS-20250327112938
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: MANZANITA VILLAGE AT RANCHO BELAGO
FACILITY NUMBER: 331881349
VISIT DATE: 01/29/2026
NARRATIVE
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The investigation revealed the following:

Allegation: Facility Staff neglected the needs of residents in care.

The detail of the complaint alleges R1-R5 has been neglected by staff: Dinner was allegedly withheld from R2 and served 2 hours later, decline in R3’s health and sudden death allegedly was a result of neglect. R4 reportedly was left soiled for an extended period without being changed. R5 allegedly was denied cake repeatedly when R5 asked for it.

On January 29, 2026, at 11:15am the Department interviewed Assistant Administrator (A2) who denied the allegation stating that no resident is ever denied food, residents are changed regularly and/or as needed. Additionally, A2 states that all staff have had Resident Rights training, and training on caring for incontinent residents. Lastly, A2 states that R3 was on hospice care at the time of her passing so A2 denies that there was neglect related to R3’s death.

On January 29,2026, between 11:30 am and 1:00pm, the Department interviewed 4 staff (S1-S4) regarding the allegation. Of those interviewed, 4 out of 4 denied the allegation stating that meals are served at the designated time and no residents are denied food. 4 out of 4 state that residents are changed regularly and as needed therefore, no resident is left soiled for extended periods of time.

On January 29, 2025, the Department observed the facility during mealtime and can confirm that the meal was served on time at time of visit. Additionally, the Department noted that there was sufficient staff present to provide adequate care and supervision to the residents.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250327112938
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: MANZANITA VILLAGE AT RANCHO BELAGO
FACILITY NUMBER: 331881349
VISIT DATE: 01/29/2026
NARRATIVE
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On January 29, 2025, the Department reviewed and evaluated the following documents: Staff in-service training on caring for incontinent residents (dated 3/6/25), Resident rights training (dated 3/27/25), R1-R5’s Service plans (dated 9/30/25, 4/30/25, 1/3/25, 1/20/26, physician’s reports (dated 4/22/25, 2/5/24, 1/8/25, 6/8/25, pre-placement appraisals (dated 2/24/24, 6/7/18), Incident/death report for R3 (dated 3/25/25), and meal schedule/menu (dated 1/25-1/31).

During review of the documents, the Department found that the facility maintains that all staff are trained in incontinent care of the residents and have received resident rights training.

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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, therefore the allegation is UNSUBSTANTIATED.

There were no deficiencies cited during today’s visit.

Exit interview conducted with Executive Director, Cristina Miller and a copy of report provided.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3