336424105-3-10-2022-18-AS-NBRN-CDLRUD-20220418131945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336424105
Report Date: 03/08/2022
Date Signed: 03/10/2022 11:57:16 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/01/2022 and conducted by Evaluator Amy Goldenberg

COMPLAINT CONTROL NUMBER: 18-AS-20220301114437

FACILITY NAME:	VALENCIA TERRACE		FACILITY NUMBER:	336424105
ADMINISTRATOR:	DYAN SUMMERELL		FACILITY TYPE:	740
ADDRESS:	2300 SOUTH MAIN STREET		TELEPHONE:	(951) 273-1300
CITY:	CORONA	STATE: CA	ZIP CODE:	92882
CAPACITY:	84	CENSUS: 68	DATE:	03/08/2022
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Edgar Gallardo, Resident Relations Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Resident's items are being stolen while in care.

INVESTIGATION FINDINGS:

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This unannounced visit by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to initiate the 10 day visit to investigate the above-mentioned complaint allegation.

During the course of this investigation visit LPA reviewed one resident record (R1), interviewed R1, and interviewed one employee (E1). LPA collected a copy of a personal property inventory for R1 and the physician's report of R1. After review of the information LPA learned the following: R1 alleges that staff are entering their bedroom and taking their personal belongings. R1 is unable to provide any name of staff that they suspect stole their property. The personal property inventory reviewed does not list any items. It is blank and signed by R1 on 10-23-2020 and it is checked that they declined to have personal property inventoried.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

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-20220301114437

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: VALENCIA TERRACE	FACILITY NUMBER: 336424105
	VISIT DATE: 03/08/2022

NARRATIVE

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R1 has personal cameras in their room but has not seen any footage to support their allegation.

Based on the available information regarding personal property inventory list and alleged stolen items, we have found the alleged violation unsubstantiated. Although the allegation may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

LIC9099 (FAS) - (06/04)

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