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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881349
Report Date: 01/30/2026
Date Signed: 01/30/2026 11:58:01 AM

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
04/11/2025 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 18-AS-20250411144423
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:
01/30/2026
UNANNOUNCEDTIME BEGAN:
08:07 AM
MET WITH:Cristina Miller and Anna MartinezTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not prevent resident from entering resident's room
Lack of supervision resulted in resident pushing another resident
INVESTIGATION FINDINGS:
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On January 30, 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 Cristina Miller, Executive Director and the purpose of the visit was explained.
Investigation consisted of the following:
On 4/16/25, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegations mentioned above. During the initial visit, 2 staff interviews were conducted. It was determined that the complaint required further investigation. On 4/25/25 and 11/21/25, subsequent visits were made and during those visit, 5 residents and 2 additional staff and Executive Director at the time Brooke Abrego-Huerta 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), R1’s Service plan, physician’s report, and pre-placement appraisals.
On January 30, 2026, the Department met with Executive Director (A1) and obtained the following documents: staff roster and resident roster (dated:1/27/26).
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026
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-20250411144423
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: 01/30/2026
NARRATIVE
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The investigation revealed the following:

Allegation: Staff did not prevent resident from entering resident's room

The detail of the complaint alleges staff did not prevent another resident from entering R1’s room.

During the initial and subsequent visits, interviews with Executive Director and staff was conducted on 4/16/25, 4/25/25 and 11/21/25. It was revealed that incident did not occur, as there had been no such incident reported to them. 4 out of 4 staff interviewed denied the allegation stating if a resident entered another resident's room staff would notice and/or it would be captured by hallway cameras. It was also revealed that some residents wander but they are redirected by staff. Of the 5 residents interviewed, 4 out of 5 residents stated they had no issues with anyone coming into their room, nor had they witnessed another resident going into another resident’s room. 1 out of 5 residents was unavailable for interview.

On January 30, 2026, the Department reviewed and the following documents: staff roster/schedule, resident roster, staff training: Understanding Wandering and Elopement and Abuse, Neglect, and Exploitation in the Elder Care setting.

During review of the documents, the Department found that the facility maintains adequate staffing to meet residents’ needs, and the staff are trained in resident behaviors including wandering behaviors.

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.

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

DATE: 01/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250411144423
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: 01/30/2026
NARRATIVE
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Allegation: Lack of supervision resulted in resident pushing another resident

The detail of the complaint alleges that a lack of supervision resulted in R1 being pushed out of bed.

During the initial and subsequent interviews with Executive Director and staff on 4/16/25, 4/25/25 and 11/21/25, it was revealed that the incident did not occur, as there had been no reports of a resident being pushed out of bed. 4 out of 4 staff interviewed during that time stated that there was no indication that R1 was pushed out of bed. Of the 5 residents interviewed, 4 out of 5 residents stated they had no not heard of a resident being pushed out of bed. 1 out of 5 residents was unavailable for interview.

On January 30, 2026, the Department reviewed and the following documents: staff roster/schedule, resident roster, staff training: Understanding Wandering and Elopement and Abuse, Neglect, and Exploitation in the Elder Care setting.

During review of the documents, the Department found that the facility maintains adequate staffing to meet residents’ needs, and the staff are trained in resident behaviors including wandering and other behaviors.

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 Cristina Miller, Executive Director and copy of report provided.

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

DATE: 01/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3