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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530032
Report Date: 07/29/2025
Date Signed: 07/29/2025 10:48:35 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
03/07/2023 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230307150845
FACILITY NAME:VILLA DE ANZAFACILITY NUMBER:
335530032
ADMINISTRATOR:KATHERINE A. TREVINOFACILITY TYPE:
740
ADDRESS:5881 EL PALOMINO DRIVETELEPHONE:
(951) 683-3333
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:197CENSUS: 143DATE:
07/29/2025
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Marc PaciaTIME COMPLETED:
10:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained pressure injury while in care
Staff handled resident in a rough manner
Residents are not being fed and changed in a timely manner
Facility has an infestation of rodents
Facility is in disrepair
Facility doesn’t have hot water
Resident wandered away from the facility due to lack of supervision
Facility has insufficient staffing to meet residents’ needs
Staff member failed to treat residents with dignity and respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Executive Director, Marc Pacia, and informed the purpose for the visit.

Regarding allegation #1, resident sustained pressure injury while in care, interviews with the two (2) residents in bedroom #254 deny having pressure injuries. Interviews with four (4) staff deny that residents in room #254 sustained pressure injuries due to staff neglect. The reporting party could not be reached for further information.

Regarding allegation #2, staff handled resident in a rough manner, interviews with the two (2) residents in bedroom #101 deny that staff handled them in a rough manner. Interviews with four (4) staff deny handling residents in bedroom #101 in a rough manner. The reporting party could not be reached for further information.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
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 3
Control Number 56-AS-20230307150845
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VILLA DE ANZA
FACILITY NUMBER: 335530032
VISIT DATE: 07/29/2025
NARRATIVE
1
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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
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31
32
Based on observations, record review, interviews with residents and staff, the allegations mentioned in this report are Unsubstantiated. An Unsubstantiated finding means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted where this report was discussed and a copy was provided with appeal rights to Executive Director Pacia at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 56-AS-20230307150845
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VILLA DE ANZA
FACILITY NUMBER: 335530032
VISIT DATE: 07/29/2025
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
Regarding allegation #3, residents are not being fed and changed in a timely manner, interviews with four (4) out of six (6) residents deny that they are not being fed or changed in a timely manner. Interviews with four (4) staff deny that residents are not being fed or changed in a timely manner

Regarding the allegation #4, facility has an infestation of rodents, LPA conducted a tour of the facility’s common areas and bedrooms and did not observe an infestation of rodents. Interviews with six (6) residents and four (4) staff deny that the facility has an infestation of rodents. Review of facility records reveals the facility is inspected monthly by a professional exterminator for rodents and other pest.

Regarding allegation #5, facility is in disrepair, LPA conducted a tour of the facility and observed the sliding doors in six (6) resident (non-ambulatory) bedrooms were working properly.

Regarding allegation #6, facility doesn’t have hot water, LPA conducted a tour of the facility and observed the hot water in six (6) resident bedrooms measured at 105- and 106-degrees Fahrenheit. Six (6) residents interviews reveal that they have hot water for showers and/or bathing.

Regarding allegation #7, resident wandered away from the facility due to lack of supervision, interviews with six (6) residents and four (4) staff deny knowing a resident with reported name that wandered away from the facility due to lack of supervision. The reporting party could not be reached for further information.

Regarding allegation #8, facility has insufficient staffing to meet residents’ needs, LPA record review reveals the facility has sufficient staff to care for the needs of the residents. Four (4) out of six (6) residents deny that staff are not meeting their needs. Four (4) staff interviews deny not meeting residents’ needs.

Regarding allegation #9, staff member failed to treat residents with dignity and respect, interviews with five (5) out of six (6) residents deny that staff failed to treat them with dignity at respect. Interviews with four (4) staff deny they fail to treat residents with dignity and respect

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3