360904812-9-11-2025-18-AS-KCLS-DLZTN5-20250930145210

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360904812
Report Date: 09/11/2025
Date Signed: 09/11/2025 12:11:46 PM

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
10/18/2021 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211018152516

FACILITY NAME:	PLYMOUTH VILLAGE OF REDLANDS		FACILITY NUMBER:	360904812
ADMINISTRATOR:	MICHAELS, JULIE		FACILITY TYPE:	741
ADDRESS:	900 SALEM DRIVE		TELEPHONE:	(909) 793-1233
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92373
CAPACITY:	303	CENSUS: 244	DATE:	09/11/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Michael Harrison, Executive Director		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Resident sustained multiple falls at the facility
Facility staff did not notify resident's representative of a change in the resident's condition
Staff left resident in soiled clothing for an extended period of time
Staff did not ensure that resident had clean linens
Facility was malodorous
Facility did not communicate with resident's representatives in a timely manner
Facility did not keep resident's records up to date
Facility did not provide resident with a written notice of eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to concluded a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Michael Harrison and explained the elements of the complaint.

Allegation #1 - Resident records reveal that resident #1 (R1) had falls at the facility and were documented. LPA obtained records of falls that were unwitnessed. Facility was in contact with R1's family members to address a change of condition and behaviors relating falls.

Allegation #2 - LPA obtained resident notes and email communication regarding R1's change of condition with R1's family members regarding the change in resident condition.

Allegation #3 - Staff records show they have been addressing R1's incontinence care needs. Records also reveal that R1 laundry service was being addressed with change of linens and resident clothing once they

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

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-20211018152516

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: PLYMOUTH VILLAGE OF REDLANDS	FACILITY NUMBER: 360904812
	VISIT DATE: 09/11/2025

NARRATIVE

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were made aware of the situation.

Allegation #4 - Records also reveal that R1's laundry service was being addressed with change of linens and resident clothing when staff was made aware of the situation

Allegation #5 - LPA toured facility at time of initial investigation and found the facility to be clean, hallways free on obstruction, with no foul odors.

Allegation #6 - LPA obtained R1's Progress notes that reveal timely communication with R1's family members pertaining to care plan meeting, increased safety checks and increase behaviors.

Allegation #7 - All records obtained during this investigation, pertaining resident care and family communication were current and up to date.

Allegation #8 - Email documentation was obtained revealing that R1 was not evicted but family members moving R1 from the facility by their accord. Records also reveal that the those family members requested specific items from the facility such as medical assessments and medication, which records reveal that those items were provided by facility staff.

Based on the information obtained there is not enough evidence to support the allegations made in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was singed by LPA Prieto and Executive Director Harrison and a copy was left with the facility.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

LIC9099 (FAS) - (06/04)

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