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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700486
Report Date: 11/04/2025
Date Signed: 11/04/2025 02:21:47 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/02/2025 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 59-AS-20251102174136
FACILITY NAME:TUSCANY VILLA CARE HOMEFACILITY NUMBER:
342700486
ADMINISTRATOR:YERBY, ANDREAFACILITY TYPE:
740
ADDRESS:8505 CLOUDCROFT WAYTELEPHONE:
(916) 385-7034
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 5DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator, Andrea YerbyTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Staff does not provide adequate supervision resulting in resident wandering away from facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 11/04/25 to do the complaint investigation for above allegation. LPA met with administrator Andrea Yerby
and explained the purpose of the visit.

From record review, administrator interview, it has been concluded that R1 AWOL from facility on 10/31/25 sometime around 12AM and was outside the facility without staff's assistance. R1s LIC602 ,dated- 01/02/25 signed by their physician disclosed that R1 cannot leave facility unassisted. From all gathered information, it has been concluded that R1 had AWOL from facility unassisted and unsupervised on 10/31/25 due to lack and care from facility. It was learnt that emergency services were called but R1 was not transferred to hospital as there were no visible injuries. Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, a deficiency is cited as listed on LIC9099-D. Exit interview was conducted .Copy of the report and appeal rights were left provided. Civil penalties shall be assessed if facility does not comply with POC requirements which were issued today.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 59-AS-20251102174136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TUSCANY VILLA CARE HOME
FACILITY NUMBER: 342700486
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2025
Section Cited
CCR
87411
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.
This requirement is not met as evidenced by;
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Administrator shall send a letter of understanding of this Regulation and shall conduct staff training, regarding AWOL risk for residents and will send training documents to CCL. POC due date is 11/05/25.
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Based on record review and interviews, it was concluded that resident, R1 was able to AWOL from the facility, unassisted on 10/31/25 , which poses an immediate risk to the health and safety of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC9099 (FAS) - (06/04)
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