Yorkshire Village

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff handled resident in an inappropriate manner.

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA met with Nicole Anguiano and explained the reason for the visit. The investigation consisted of the following: On 10/6/23 LPA Martinez conducted an initial complaint investigation visit and requested pertaining documents. On 10/30/25 LPA Flores conducted an interview with administrator and business office manager over the phone and requested resident #1(R1)’s physician report, needs and care plan, admission agreement, and face sheet. On 11/3/25 LPA Flores conducted interviews with 4 staff and 8 residents. LPA attempted to contact R1’s responsible party. The investigation revealed the following: Regarding allegation: Staff handled resident in an inappropriate manner. It is alleged staff mishandled a resident while outside the facility. (CONTINUED ON LIC 9099C) Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 3, 2025 · control 18-AS-20231002082742

Allegation investigated: Staff did not report emergency to the Long-Term Care Ombudsman office Staff unable to provide emergency personnel with resident census Staff was unable to provide emergency personnel with residents' records Staff did not execute evacuation plan. Facility did not have adequate staff to meet the needs of the residents in care

On 09/17/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering investigative findings into the allegations listed above. LPA Flores identified herself and discussed the purpose of the visit with Wellness Director, Haley Logan. The investigation consisted of record reviews and interviews. The allegations stem from an emergency incident that occurred at the facility on 03/14/2025. Information received alleged staff did not report emergency to the Long-Term Care Ombudsman (LTCO). Community Care Licensing (CCL) is regulated by Title 22. Per Title 22 regulations, section 87211(c) Reporting Requirements requires a report to the LTCO for incidents of physical abuse, abandonment, abduction, isolation, financial abuse and neglect. The emergency occurring on 03/14/2025 was not for any of the above mentioned incidents. (Continue to LIC9099) Unfoundedthe state’s words, verbatim · CDSS document, Sep 17, 2025 · control 18-AS-20250317191114

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff mismanaging medication.

LPA Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Nicole Anguiano and explained the reason for the visit. The investigation consisted of the following: On 6/1/22 LPA George conducted an initial investigation visit. On 9/10/25 LPA Flores contacted administrator via telephone and requested a copy of staff/resident roster. On 9/12/25 LPA interviewed 6 staff over the phone. On 9/15/25 LPA Flores conducted an unrelated complaint investigaiton visit and reviewed medication for 9 residents and interviewed 9 residents. On 9/16/25 LPA delivered findings for above allegations. The investigation revealed the following: Regarding allegation: Staff are mismanaging medication. It is alleged that staff are mismanaging the residents medications. (CONTINUED ON LIC 9099C) Substantiatedthe state’s words, verbatim · CDSS document, Sep 16, 2025 · control 18-AS-20220531160519

Allegation investigated: Resident is being neglected

LPA Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Nicole Anguiano Office Manager and explained the reason for the visit. The investigation consisted of the following: On 11/30/22 LPA Nwogene conducted an initial investigation visit. On 9/10/25 LPA Flores contacted administrator via telephone and requested a copy of staff/resident roster and pertaining documents. On 9/12/22 LPA conducted interviews with 6 staff over the phone. On 9/15/25 LPA Flores conducted an unrelated complaint investigation visit at the facility and toured the facility and interviewed 9 residents. Regarding allegation: Resident is being neglected. It is alleged that resident #1(R1) was found on 11/28/22 not assisted with toileting needs. LPA was unable to interview R1, as R1 is no longer at the facility. Interviews with residents revealed 9 out of 9 residents stated staff provides care with toileting needs as needed. (CONTINUED ON LIC 9099C) Unthe state’s words, verbatim · CDSS document, Sep 16, 2025 · control 18-AS-20221128115055

Allegation investigated: Resident is being neglected while in care Resident is being left unattended in soaking wet clothing with feces for extended periods of time

LPA Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Nicole Anguiano and explained the reason for the visit. The investigation consisted of the following: On 12/21/22 LPA Arreola conducted an initial investigation visit. On 9/10/25 LPA Flores contacted administrator via telephone, requested a copy of staff/resident roster, and requested pertinent documents. On 9/12/25 LPA interviewed 6 staff over the phone. On 9/15/25 LPA Flores conducted a visit and interviewed 9 residents. On 9/16/25 LPA Flores delivered findings. Regarding allegation: Resident is being neglected while in care. It is alleged residents are being left unattended. Interviews with residents revealed 9 out of 9 residents stated staff provide residents with care and respond when they call for assistance. Residents stated to use the call light cord, phone, or walk to staff when in need of assistance. Resident #1(R1) was unable to be interviewed as R1 is nthe state’s words, verbatim · CDSS document, Sep 16, 2025 · control 18-AS-20221214131706

Allegation investigated: Staff speaks inappropriately to residents in care Staff are not answering residents call bells timely

LPA Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Nicole Anguiano Office Manager and explained the reason for the visit. The investigation consisted of the following: On 11/17/22 LPA Danielson conducted an initial investigation visit. On 9/10/25 LPA Flores contacted administrator via telephone and requested a copy of staff/resident roster. On 9/12/25 LPA Flores interviewed 6 staff over the phone. On 9/15/25 LPA Flores conducted a tour of 9 resident rooms with Bianey Sandoval Wellness Coordinator and interviewed 9 residents. Regarding allegation: Staff speaks inappropriately to residents in care. It is alleged staff members curses at the residents.Interviews conducted with residents revealed staff are respectful when communicating with the residents and do not use foul language. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 15, 2025 · control 18-AS-20221109082654

Allegation investigated: Staff neglect/lack of supervision resulted in resident's death.

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA Abdoulaye met with Office Manager Nicole Aguiano and explained the reason for the visit. On 12/01/2023, the Riverside Adult and Senior Care Regional Office (RO) received a complaint of an allegation of staff neglect/lack of supervision resulted in resident’s death. When Resident #1 (R1) arrived at the hospital on 08/02/2023, R1 was found to have bilateral skull fractures and brain bleeds, along with aspiration pneumonia. R1’s condition progressively worsened, and R1 died at the hospital on 08/11/2023. It was alleged the death of R1 from bilateral head bleeds was inconsistent with the single unwitnessed ground level fall that the facility reported. A review of the Unusual Incident/Injury Report submitted by the facility documented on 08/02/2023, at around 12:15pm, Staff #1 (S1) heard a stomp sound coming from R1’s room and fthe state’s words, verbatim · CDSS document, Sep 11, 2025 · control 18-AS-20231201143530

Allegation investigated: Staff did not report incidents to licensing.

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted a subsequent complaint visit to deliver findings for the above noted allegation. LPA Abdoulaye was greeted and granted entrance by Office Manager Nicole Aguiano. LPA Abdoulaye Zerbo identified himself and discussed the purpose of the visit. It was alleged that staff did not report incidents to licensing. Concerns were raised that the incidents mentioned in the eviction notice were not reported to licensing and the Ombudsman. LPA conducted a records review, and the information obtained revealed that the eviction notice listed 23 incidents involving R1, but only 2 out of the 23 incidents were reported to licensing. Based on records review, the allegation that staff did not report an incident to licensing 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, Healtthe state’s words, verbatim · CDSS document, Sep 11, 2025 · control 18-AS-20240207131041

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff do not ensure residents are provided nutritious meals. Staff did not safeguard resident's personal belongings.

On 5/21/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to deliver findings regarding the allegation listed above. LPA met with Office Manager, Nicole Anguiano who was informed of the purpose of the visit. Regarding the allegation, “Staff do not ensure residents are provided nutritious meals” it was alleged staff do not ensure Resident 1 (R1) receives a nutritious meal. LPA reviewed R1’s Identification and Emergency Information (LIC 601) dated 1/5/2024 noting R1 was admitted to the facility on 1/8/2024 and had a responsible person. LPA reviewed R1’s signed physician’s report dated 5/28/24 indicating R1 does not require a special diet and has a capacity to feed themselves. LPA reviewed the facility’s menu, which meets the Department’s general food service requirements. LPA conducted an interview with R1’s responsible person who corroborated the allegation and reported the facility frequently served a tuna sandwich or hot dog with chips forthe state’s words, verbatim · CDSS document, May 21, 2025 · control 18-AS-20240531131008

Allegation investigated: Staff yelled at a visitor in front of residents

On 09/11/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to deliver an amended version of the original report in regard to the allegation listed above. LPA met with Office Manager (OM), Nicole Anguiano who was informed of the purpose of the visit. Regarding the allegation, “Staff yelled at a visitor in front of residents” it was alleged Administrator Teresa Mapilis yelled at a visitor near OM Anguiano’s office. It was further alleged the incident occurred in the presence of approximately 20 to 25 residents and OM Anguiano. The reporting party was unable to identify the identities of any of the alleged resident witnesses. As a result, LPA attempted to conduct an interview with a random sample of the population. Five (5) residents were unqualified for an interview as LPA determined them to be unreliable historians. *This is an amended version of the original report. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 21, 2025 · control 18-AS-20240606081652

Allegation investigated: Staff did not safeguard a resident while in care Staff did not follow appropriate reporting requirements

On May 13, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced and met with Administrator, Teresa Mapilis. LPA explained the purpose for the visit was to provide findings for the complaint investigation. On November 15, 2022, Community Care Licensing received a complaint alleging staff did not safeguard a resident while in care and staff did not follow appropriate reporting requirements. During the investigation LPA conducted interviews and record reviews. Regarding the allegation staff did not safeguard a resident while in care, it was reported on August 09,2022, family members abducted Resident from the facility and placed Resident in another assisted living facility. Information obtained from interview with Administrator denied the allegation. Additional information obtained from interview with Administrator stated Resident was removed from the facility on July 1, 2022. An exit interview was conducted and a copy of this report was provided to Admithe state’s words, verbatim · CDSS document, May 13, 2025 · control 18-AS-20221115152403

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff mismanaged resident's medication Staff restrained resident in care

On May 13, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced and met with Teresa Mapilis, Administrator. LPA explained the reason for the visit was to provide findings for the complaint investigation. On March 11, 2025, Community Care Licensing received a complaint alleging staff mismanaged resident’s medication and staff restrained resident in care. During the investigation, LPA conducted interviews, record reviews, and made observations. It was reported facility staff was giving Resident 300 mg of a medication when their physician's order stated 200mg. Additionally it was reported on March 7, 2025, a Geri chair was observed to be pushed up against Resident’s bed to deter Resident from exiting or falling out of the bed. Regarding the allegation staff mismanaged resident’s medication, it was reported facility staff was giving Resident 300 mg of a medication when Resident’s Physician's Order prescribed only 200mg. Information obtained from interviewthe state’s words, verbatim · CDSS document, May 12, 2025 · control 18-AS-20250311133731

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff member physically abused resident in care.

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced subsequent visit to the facility to investigate the above allegation. LPA met with business office director, Nicole Anguiano, who was informed of the purpose of the visit. Throughout the investigation, LPA conducted a walk through, interviews and records review. The complaint alleged that staff member physically abused residents in care. On August 22, 2024, LPA and Wellness Director, Eloisa Mireles, discussed about the allegations. Eloisa stated that it was indeed one resident's aggressive act on another resident, not staff abusing residents. LPA's review of residents' files revealed both individuals were residents at this facility. Eloisa sent SOC341 and incident report as usual but did not know how the complaint was filed as staff abusing residents. Continued on LIC9099-C Unfoundedthe state’s words, verbatim · CDSS document, Oct 25, 2024 · control 18-AS-20240815102419

Allegation investigated: Due to lack of supervision, resident got into a physical altercation with another resident

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced subsequent complaint visit to the facility and met with the Business Office Director, Nicole Anguiano, informing them of the purpose of the visit. Throughout the investigation, LPA interviewed staff and residents, reviewed files, and obtained supporting documentation to aid in determining the findings of the noted allegation. On August 29, 2024, Community Care Licensing received a complaint report alleging that due to lack of supervision, a resident got into a physical altercation with another resident. During LPA’s initial 10-day visit on August 30, 2024, a review of resident files revealed both Resident #1 (R1) and Resident #2 (R2) were residents at the facility. Continued on LIC9099-C.... Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 25, 2024 · control 18-AS-20240829145120

Allegation investigated: Staff verbally abuse resident Staff physically abused resident

Licensing Program Analyst (LPA) Sara Martinez arrived unannounced to the facility to conclude the investigation into the allegation listed above. LPA met with Wellness Director Eloisa Mireles and explained the purpose of the visit. The complaint investigation consisted of a tour of the interior/exterior areas of the facility, observations, interviews with staff and residents, and records review of requested pertinent documents. Regarding the allegation “Staff verbally abuse resident” it was reported staff was verbally aggressive to Resident One (R1). Interview with R1 reveled it was not staff who was being verbally aggressive to R1 but Resident Two (R2). Interviews with staff and residents denied staff being verbally aggressive to residents and denied witnessing staff being verbally aggressive to R1 while in care. Regarding the allegation “Staff physically abused resident” it was reported staff had grabbed R1 by the arm and pulled R1. Interview with R1 revealed it was not staff who hadthe state’s words, verbatim · CDSS document, Aug 12, 2024 · control 18-AS-20240308165256

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff are administering medication to resident not consented by POA. Staff are not meeting resident's hygiene needs. Staff did not ensure resident used her walking device.

On June 21, 2024, Licensing Program Analyst (LPA), Venus Mixson conducted an unannounced visit and met with the Administrator, Teresa Mapilis. The visit was conducted to provide the findings for the investigation pertaining to the listed allegations. LPA interviewed staff, residents, and witness and conducted record reviews. LPA was unable to interview Resident Number 1 (R1) due to Resident refusing to speak with department staff. On January 17, 2024, Community Care Licensing (CCL) received a complaint that Staff are administering medication to resident not consented by POA, Staff are not meeting resident's hygiene needs, and Staff did not ensure resident used their walking device. Regarding the allegation of Staff are not meeting resident's hygiene needs, it was reported that R1 was brought into the doctor’s office and was observed to be dirty, smelled like urine. On another occasion it was reported that R1's diaper was observed to be on the outside of their clothes, R1's skin was drythe state’s words, verbatim · CDSS document, Jun 21, 2024 · control 18-AS-20240117092257

Allegation investigated: Illegal eviction

Licensing Program Analyst (LPA), Yolanda Delgado made an unannounced visit to the facility to investigate a complaint regarding the allegation listed above. LPA met with Administrator, Teresa Mapilis and explained the purpose of the visit and the elements of the allegation. LPA Delgado conducted the investigation which consisted of interview with staff member and record review. On May 14, 2024, Community Care Licensing received a complaint stating illegal eviction. The allegation stated that the facility wrongfully evicted Resident #1 (R1), facility accused R1 of incorrect information, R1 threatened and harassed the other residents, R1 received a 30-day written notice. During the LPA’s investigation, LPA attempted 3 times to contact R1 with no return calls received. (Continued on Page 2) Unfoundedthe state’s words, verbatim · CDSS document, May 22, 2024 · control 18-AS-20240514110222

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff did not notify responsible party of change of resident's health condition.

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegation. The LPA met with Administrator, Teresa Mapilis, and informed her of the purpose for her visit. A report was received by the Department alleging the facility did not notify family members of residents currently experiencing rashes. On this visit the LPA conducted staff and resident interviews, reviewed records and obtained copies of pertinent documentation. Nine resident interviews were conducted; of the nine, four residents reported they currently had a rash on their body. According to Administrator, Teresa Mapilis, there about seven residents in building B who currently have a rash. One third party interview revealed the responsible party of Resident One (R1) was not notified of the resident's rash. An interview with Administrator Mapilis revealed the responsible party of R1 was not notified by the facility due to the resident receivthe state’s words, verbatim · CDSS document, Apr 22, 2024 · control 18-AS-20240417082812

Allegation investigated: Staff did not ensure facility is kept free of bed bugs.

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegation. The LPA met with Administrator, Teresa Mapilis, and informed her of the purpose for her visit. A report was received by the Department alleging there are residents in care who have rashes, all over their bodies, which appear to be bed bug bites for which the facility has not provided treatment. On this visit the LPA conducted staff and resident interviews, reviewed records and obtained copies of pertinent documentation. Nine resident interviews were conducted; of the nine, four residents reported they currently had a rash on their body. One of the four residents reported the facility is treating the rash; another resident reported the facility was not treating the rash; and the remaining two residents could not provide any information on whether their rash was being treated. According to Administrator, Teresa Mapilis, there are aboutthe state’s words, verbatim · CDSS document, Apr 22, 2024 · control 18-AS-20240417082812

Allegation investigated: Resident was physically assaulted by another resident which resulted in injuries due to lack of supervision.

Licensing Program Analyst (LPA), Jacqueline Shaw Ross made an unannounced visit to deliver findings for the allegations noted above. LPA met with Nicole Anguiano, Business Office Manager, and explained the purpose of the visit and the elements of the allegations. The investigation consisted of observations, interviews, and records review. On 1/5/2024, Community Care Licensing received an allegation that a resident was physically assaulted by another resident that resulted in injuries. It was reported that R2 became agitated with R1 over a comment that was made by R1. R2 began yelling at R1 and grabbed R1's left arm, leaving a bruise. R1 called the police, and police arrived however no charges were filed. LPA interviewed staff who corroborated that the incident did occur. The assault was witnessed by a newly hired staff member who was taking a video training course. LPA interviewed R1 who stated there was concern there was not enough supervision which led to the assault. Substantiatedthe state’s words, verbatim · CDSS document, Feb 23, 2024 · control 18-AS-20240105081727

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.