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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 04:02:48 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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/24/2023 and conducted by Evaluator Javier Prieto
COMPLAINT CONTROL NUMBER: 56-AS-20230524101225
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:
12:45 PM
MET WITH:Marc Pacia, Executive DirectorTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Facility has an aggressive animal on the premises.

Residents are left soiled for a long period of time.

Facility staff are not properly trained.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conclude a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Pacia and explained the elements of the complaint.

Allegation #1 - During time of investigation, the facility had 2 resident's, each owning 1 small dog. Resident #1 (R1), has a small dog, docile and well tempered. The room was clean and free of odors. R2 has a small dog, docile and well tempered. The room was clean and free of odors. None of the animals showed signs of aggression to LPA or accompanied staff.

Allegation #2 - LPA interviewed R1 to R10, none of which stated that they had been left in solied diapers for a long period of time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
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 2
Control Number 56-AS-20230524101225
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
, CA 92507
FACILITY NAME: VILLA DE ANZA
FACILITY NUMBER: 335530032
VISIT DATE: 07/29/2025
NARRATIVE
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Allegation #3 - Business Manager provided LPA with the latest list of training provided to staff on the topics of mandated in service training, including Resident Rights and Dignity, Mandated Reporting, Understanding Resident's Rights and Staff Responsibilities in Upholding Resident's Rights. Other training topics include Hoyer Lifts, Colostomy bags, HIV, Incontinence care, Transfers, Walking Downstairs, Fire Safety and Skin Integrity.

Based on the information obtained there is not enough evidence to support the allegations in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Pacia and a copy was left with the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
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 2