331881349-2-10-2026-18-AS-RORN-DRDTMQ-20260217135131

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881349
Report Date: 02/10/2026
Date Signed: 02/10/2026 11:43:15 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
03/27/2025 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 18-AS-20250327112938

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:	150	CENSUS: 122	DATE:	02/10/2026
		UNANNOUNCED	TIME BEGAN:	07:58 AM
MET WITH:	Anna Martinez		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff neglected the needs of residents in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

**On February 10, 2026, the Department conducted a subsequent visit to facility. The purpose of the visit is to include additional information in the report dated 1/29/26 required to justify the finding which will remain the same. The department met with and Anna Martinez, Assistant Executive Director and explained purpose of visit.

Investigation consisted of the following:
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.
On April 2, 2025, 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 9/11/25, subsequent visits were made and during those visits, 5 resident and 3 witness interviews were conducted. However, no findings were rendered.
Page 1 of 3

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026

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: 02/10/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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). On January 29, 2026, The Department conducted interviews with Assistant Administrator (A2), and 4 staff (S1-S4)
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 April 2, 2025, the Department interviewed 3 residents regarding the allegation, and on April 25, 2025, 5 additional residents were interviewed. 8 out of 8 residents denied the allegation, stating that staff provide appropriate care and they have not experienced neglect. Each resident confirmed that dinner is always served on time, snacks are never withheld, and 8 out of 8 residents indicated that they have never been left soiled for an extended period.

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.

Page 2 of 3

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026

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: 02/10/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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, 2026, the Department observed the facility during mealtimes 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.

On January 29, 2026, 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 1/25-1/31/25).

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.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3