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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604169
Report Date: 07/24/2025
Date Signed: 07/29/2025 08:46:20 AM

Substantiated


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
07/07/2025 and conducted by Evaluator Valerie Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250707144951
FACILITY NAME:VILLA AMBROSIAFACILITY NUMBER:
374604169
ADMINISTRATOR:DRAPEAU, YORADYLDAPFACILITY TYPE:
740
ADDRESS:1537 BRIGHTON GLEN ROADTELEPHONE:
(760) 290-3444
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:6CENSUS: 3DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Administrator, Ali NaghibiTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Resident eloped due to lack of care and supervision
INVESTIGATION FINDINGS:
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On 7/24/2025, Licensing Program Analyst (LPA) Valerie Flores arrived at the facility for the purpose of delivering findings into the complaint investigation for the allegation listed above. LPA Flores met with Administrator, Ali Naghibi and explained the purpose of the visit. The investigation consisted of record review, observations, and interviews.
On 7/7/2025, Community Care Licensing (CCL) received a complaint alleging Resident #1 (R1) eloped from the facility due to lack of care and supervision. Interviews obtained revealed Staff #1 (S1) was in the backyard with R1. S1 returned back into the facility to begin prepping for lunch. R1 remained outside unsupervised while other care staff were assisting other residents. R1 pushed open the exterior side gate of the facility and wander into the front yard of a neighboring house. The facility staff gained knowledge of R1’s elopement when a neighbor knocked on the facility door and advised S1 that they believed a resident from the facility was at the neighbors doorstep.

(Continue to LIC9099C...)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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 18-AS-20250707144951
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: VILLA AMBROSIA
FACILITY NUMBER: 374604169
VISIT DATE: 07/24/2025
NARRATIVE
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(Continuation from LIC9099)

Staff #3 (S3) was advised by Staff #2 (S2) to supervise the residents in care while S1 and S2 stepped away to redirect R1 back into the facility. S1 and S2 walked over to the neighbors front yard and witnessed R1 sitting outside on the neighbors porch. Staff attempted to redirect R1 back into the facility. R1 refused to return to the facility resulting to S1 calling Law Enforcement and notifying R1’s Power of Attorney (POA). R1’s POA arrived approximately 30 minutes later and successfully redirected R1 into the facility.
Based on interviews and records review, the allegation that a resident eloped from the facility due to lack of supervision was determined to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. Pursuant to the California Code of Regulations, Title 22, Division 6, Health and Safety Code, a deficiency is cited on the attached LIC 9099-D.

An exit interview was conducted and a copy of this report, along with the Appeal Rights (LIC 9058 03/22) were provided to Administrator, Ali Naghibi.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250707144951
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: VILLA AMBROSIA
FACILITY NUMBER: 374604169
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/08/2025
Section Cited
HSC
1569.312(d)
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Every facility required to be licensed under this chapter shall provide at least the following basic services: (d)Being aware of the resident's general whereabouts, although the resident may travel independently in the community. This requirement is not met based as
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Administrator stated that an updated appraisal will be conducted for residents when changes are noticed. Administrator further stated an in-house training will be conducted to ensure care staff have appropriate shift coverage to ensure proper
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evidence by interview and record review:
Facility staff did not have knowledge of one (1) out of three (3) residents whereabouts which poses a potential health and safety risk for the resident in care.
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 care and supervision the residents. This in-house training will be emailed to LPA once
completed by 8/8/2025, Close of Business.
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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: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
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