331881066-6-4-2026-18-AS-RORN-DUVNTD-20260609104435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881066
Report Date: 06/04/2026
Date Signed: 06/04/2026 02:01:27 PM

Unsubstantiated

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
09/09/2024 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 18-AS-20240909101100

FACILITY NAME:	REM CALIFORNIA, LLC - SKYLAND		FACILITY NUMBER:	331881066
ADMINISTRATOR:	FLORENCE, TAMARA		FACILITY TYPE:	735
ADDRESS:	24795 SKYLAND DR		TELEPHONE:	(951) 601-3444
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92557
CAPACITY:	4	CENSUS: 4	DATE:	06/04/2026
		UNANNOUNCED	TIME BEGAN:	10:28 AM
MET WITH:	Brandy Hamilton		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff are not meeting resident's dental hygiene needs.
Staff did not seek timely medical treatment for changes in resident's health condition.

INVESTIGATION FINDINGS:

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On June 4, 2026, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegations and to deliver findings. The Department was met by Brandy Hamilton, House Manager and reason for visit explained. The facility currently has 4 clients in placement.
Investigation consisted of the following:
On September 16, 2024, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegation mentioned above. During the visit, it was determined that the complaint required further investigation.
On June 3, 2026, the department conducted an unannounced visit to continue investigation of above allegations and to deliver findings. During that visit, the department obtained and reviewed the following documents: staff schedule (date 5/31/26), Client roster (dated: 6/3/26 ), LIC 602 Physician’s Report (dated 5/3/24), Admissions Agreement (dated 4/13/22), Individual Service Plan (dated 8/9/24), Medication Administration Records (MARs) for July–September 2024 ,Weight logs / vitals logs (date range 4/4/22-6/2/26), Email communication from Dietitian to facility (dated: 12/11/25), Bowel movement records : (Date range 10/24-12/24), Staff communication logs / shift notes (date range 6/30/24-8/2/24), Medical visit records (date range 8/9/24-9/16/24) , Dental consent form signed by mother (9/27/24),Medical clearance (6/26/24), Emergency procedures / facility medical emergency policy (No date). The department conducted 1 Administrator interview (A1) and 1 staff interview (S1). During this visit it was determined that there is a need for further investigation as more interviews are needed.
On June 4, 2026, the department conducted 3 staff interviews (S2-S4 ).
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

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 18-AS-20240909101100

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: REM CALIFORNIA, LLC - SKYLAND	FACILITY NUMBER: 331881066
	VISIT DATE: 06/04/2026

NARRATIVE

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The investigation revealed the following

Allegation: Staff are not meeting resident's dental hygiene needs.

The detail of complaint alleges C1’s had an abscessed cavity that has not been treated. Emergency medical consent was needed and signed by C1’s responsible party, however C1 was turned away for the dental service at that time due to “malnutrition.”

On June 3, 2026, the Department interviewed the Administrator (A1), who reported that she had been in the position for approximately one year and therefore she could not give any information during the interview portion of the investigation. However, she provided the Department with relevant documentation pertaining to the matter.

On June 3, 2026, the Department also interviewed one staff member (S1), who denied the allegation. S1 explained that C1 experienced certain issues that delayed the dental services, but the delay was not due to neglect. Rather, C1 required medical clearance because he needed to be sedated for the procedure, which necessitated consent and physician approval. S1 further stated that C1 was ultimately cleared, the dental procedure was completed without complications, and the responsible party was satisfied with the outcome.

C1 was not interviewed as he is non- verbal and this was evident through review of records and observation.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20240909101100

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: REM CALIFORNIA, LLC - SKYLAND	FACILITY NUMBER: 331881066
	VISIT DATE: 06/04/2026

NARRATIVE

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On June 4, 2026, the department interviewed 3 staff members (S2-S4) of those interviewed, 3 out of 3 denied the allegation listed above stating that the facility maintains the client dental hygiene needs. 2 of 3 staff were not working at facility during time of complaint so they could not speak to any issues during that time, but was able to say with certainty that presently the client’s dental needs are taken care of.

On June 3, 2026, the Department reviewed and assessed the following documents: LIC 602 Physician’s Report (dated 5/3/24), Medication Administration Records (MARs) for July–September 2024, staff communication logs/shift notes (dated 6/30/24–8/2/24), medical visit records (dated 8/9/24–9/16/24), a dental consent form signed by the mother (dated 9/27/24), and the medical clearance (dated 6/26/24).

The documentation showed that the facility followed physicians’ orders and proper procedures to ensure that C1 received treatment for his dental needs.

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation: Staff did not seek timely medical treatment for changes in resident's health condition.

The detail of the complaint alleges that C1’s health condition declined because the facility failed to provide or seek timely medical treatment.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20240909101100

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: REM CALIFORNIA, LLC - SKYLAND	FACILITY NUMBER: 331881066
	VISIT DATE: 06/04/2026

NARRATIVE

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On June 3, 2026, the Department interviewed the Administrator (A1), who denied the allegation. A1 stated that C1 was not in a declining health state and was stable when she assumed her role. She noted that she could not speak to C1’s condition at the time the complaint was filed but provided the Department with relevant documentation from the time period in question.

On June 3, 2026, the Department observed C1 to be clean, well groomed, and engaged in eating lunch. During the visit, C1 was seen walking throughout the facility with his 1:1 staff. LPA observed that C1 ambulated independently without assistance and appeared proportionate in height and weight.

On June 4, 2026, the department interviewed 3 staff members (S3-S4) of those interviewed, 2 out of 3 stated that since they have worked at the facility, C1 has not had a decline in his medical health. 1 of the 3 was around during the time of complaint and does remember that there was a time when C1 had issues with not wanting to eat or to get out of bed. This staff went on to state that the facility followed up with health care professionals regarding C1 condition and it was ultimately resolved and C1 returned to baseline.

On June 3, 2026, the Department reviewed and evaluated the following documents: LIC 602 Physician’s Report (dated 5/3/24), Individual Service Plan (dated 8/9/24), Medication Administration Records (MARs) for July–September 2024, weight and vitals logs (dated 4/4/22–6/2/26), email communication from the dietitian to the facility (dated 12/11/25), bowel movement records (dated 10/24–12/24), staff communication logs/shift notes (dated 6/30/24–8/2/24), and medical visit records (dated 8/9/24–9/16/24).

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20240909101100

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: REM CALIFORNIA, LLC - SKYLAND	FACILITY NUMBER: 331881066
	VISIT DATE: 06/04/2026

NARRATIVE

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The reviewed documents indicated that the facility consistently monitored C1’s medical condition, maintained appropriate records, and communicated concerns to C1’s Primary Care Physician, Nurse Practitioner, and Dietitian. Although the weight record/log showed some fluctuations in C1’s weight, the records clearly reflected that these changes were likely associated with medication side effects, and C1’s physician adjusted the medication accordingly to return him to baseline.

There were no deficiencies cited during today’s visit. Exit interview conducted and copy of report provided.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

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