331881066-6-5-2026-18-AS-RORN-DUXRPZ-20260611131244

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881066
Report Date: 06/05/2026
Date Signed: 06/05/2026 12:07:55 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
12/17/2024 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 18-AS-20241217131506

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:	06/05/2026
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Jacqueline Arias		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Licensee did not make provision for carrying out of the administrator's responsibilities during absence of administrator
Licensee did not ensure facility staff are able to perform incidental medical assistance to resident with colostomy bag as needed
Licensee did not ensure facility has food in the quantity necessary

INVESTIGATION FINDINGS:

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On June 5, 2026, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation and to deliver findings of the above allegations. The Department was met by Jacqueline Arias and reason for visit explained. The facility currently has 4 clients in placement.
Investigation consisted of the following:
On December 19, 2024, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegations mentioned above. During the visit, it was determined that the complaint required further investigation.
On June 4, 2026, the department conducted an unannounced visit to continue investigation of above allegations. The department obtained and reviewed the following documents: staff schedule (date 5/31/26), Client roster (dated:6/3/26), C1’s LIC 602 Physician’s Report (dated 5/22/26), C1’s Restricted Healthcare plan (dated 1/14/26, 3/19/24,) staff training on colostomy changing (dated 3/13/24), C1’s Individual Service Plan (dated 4/25/24), C1’s Individual Program Plan (IPP)-- (dated: 4/30/25), current Administrator Certificates for A1, A2, A3 (expiration dates: 1/2/28/27, 7/18/27,1/16/27), and Administrator responsibility log. During this visit it was determined that there is a need for further investigation as more interviews are needed.
On June 5, 2026, the department interviewed 1 Administrator, 4 staff (S1-S4 ), and 1 client (C1)
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026

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 4

Control Number 18-AS-20241217131506

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: 06/05/2026

NARRATIVE

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The investigation revealed the following

Allegation: Licensee did not make provision for carrying out of the administrator's responsibilities during absence of administrator

The detail of the complaint alleges there was no administrator in the home and there is a lack of communication with the “covering administrator.”

On June 5, 2026, the department interviewed Administrator (A1) who denied allegation stating that there has always been an administrator in the facility and that they are accessible for the staff when they need support.

On June 5, 2026, between 10:00am and11:00am the department interviewed 4 Staff (S1-S4) regarding the allegation and of those interviewed 4 out 4 stated that the administrator is always available and provide support when needed.

On June 4, 2026, the department reviewed and evaluated the following documents: Administrator certificates, administrator schedule and administrator responsibilities. All certificates reviewed were current.

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.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20241217131506

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: 06/05/2026

NARRATIVE

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Allegation: Licensee did not ensure facility staff are able to perform incidental medical assistance to resident with colostomy bag as needed

The details of the complaint allege that staff are not equipped to provide care to C1, who has a colostomy bag.

On June 5, 2026, the department interviewed Administrator (A1) who denied allegation stating all staff are trained on C1’s restricted health care plan. The training is conducted by a medical professional. A1 also states that that various quality control methods are used such as “pop up” monitoring of staff as they are completing the tasks to ensure they are properly completing the task. Additionally, A1 stated that an LVN comes to the facility weekly to monitor progress.

On June 5, 2026, between 10:00am and 11:00am, the department interviewed 4 staff regarding the allegation and of those interviewed 4 out of 4 staff state they are trained and competent in performing tasks of caring for a client with a colostomy bag

On June 4, 2026, the department reviewed and evaluated the following documents: C1’s Restricted Healthcare plan (dated 1/14/26, 3/19/24) staff training on colostomy changing (dated 3/13/24).

On June 4, 2026, the department interviewed 1 client (C1) who stated that he feels safe and cared for at the facility. When asked if the staff assist him with his colostomy care daily, he replied “yes” and when asked if there has been any time that he felt that staff didn’t properly provide colostomy care, he replied “no, they always help me.”

On June 5, 2026, the department observed C1 to be well-groomed, clean, and free of any odors. His room was also observed to be clean, safe, and sanitary.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 18-AS-20241217131506

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: 06/05/2026

NARRATIVE

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Allegation: Licensee did not ensure facility has food in the quantity necessary

The detail of the complaint alleges “there was no funds available for food due to no administrator on site.”

On June 5, 2026, the department interviewed Administrator (A1) who denied the allegation stating funds for food were always available.

On June 5, 2026, between 10:00am and 11:00am, the department interviewed 4 staff (S1-S4) and of those interviewed 4 out of 4 denied the allegation stating that there has never been a short of food supply.

On June 5, 2026, the department interviewed 1 client (C1) who stated that he gets enough food to eat daily, and he has never been without food.

On June 5, 2026, the department observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. Additionally, the department observed an ample supply of emergency food and water properly stored.

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: 06/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026

LIC9099 (FAS) - (06/04)

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