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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800187
Report Date: 11/25/2024
Date Signed: 11/25/2024 01:40:00 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
11/20/2024 and conducted by Evaluator Sarina Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241120141939
FACILITY NAME:ROSE VALLEY REDLANDSFACILITY NUMBER:
361800187
ADMINISTRATOR:GLENN BERNALFACILITY TYPE:
740
ADDRESS:153 S DEARBORN STTELEPHONE:
(909) 389-7586
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:6CENSUS: 6DATE:
11/25/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:House Manager Mistie FeltonTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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2
3
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8
9
Staff consume liquor while on shift
Staff do not have fingerprint clearance
Staff lock facility doors to prevent residents from leaving
Staff insert suppositories to residents in care
Staff did not complete required trainings
Staff facility records are falsified
Staff did not maintain resident records
Residents are not provided proper food service
Staff did not ensure resident’s diapering needs were met
INVESTIGATION FINDINGS:
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5
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13
Licensing Program Analysts (LPAs) Sarina Ramirez and Becky Mann conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPAs met with House Manager Mistie Felton, and discussed the purpose of the visit.

Regarding the allegation #1 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs staff do not consume liquor while on shift.

LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs staff do not consume liquor while on shift.

Regarding the allegation #2 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs all staff have fingerprint clearance, LPAs observed and reviewed records showing all staff
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
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 3
Control Number 56-AS-20241120141939
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ROSE VALLEY REDLANDS
FACILITY NUMBER: 361800187
VISIT DATE: 11/25/2024
NARRATIVE
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have fingerprint clearance.

Regarding the allegation #3 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs staff do not lock doors to prevent residents from leaving, 2 out of the 3 staff stated doors are locked at night when residents are sleeping.

LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs the doors are not locked to prevent them from leaving

Regarding the allegation #4 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs staff do not insert suppositories in residents.

LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs staff do no insert suppositories in residents.

Regarding the allegation #5 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs staff complete all required trainings. LPAs observed and reviewed records all staff have all required trainings.

Regarding the allegation #6 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs staff records are not falsified. LPAs observed and reviewed records and no staff records are falsified.

Regarding the allegation #7 LPA Ramirez and LPA Mann reviewed and observed staff maintain resident records.

Regarding the allegation #8 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs residents are provided proper food service

LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs residents are provided with proper food service.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20241120141939
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ROSE VALLEY REDLANDS
FACILITY NUMBER: 361800187
VISIT DATE: 11/25/2024
NARRATIVE
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3
4
5
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Regarding the allegation #9 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs there are no residents in care that need assistance with diaper needs, however 3 out of the 3 staff stated they will assist with diaper needs if needed.

LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs they do not need diaper assistance and can independently use the restroom on their own.

Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated; meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted where this report was discussed and appeal rights were provided to House Manager Mistie Felton at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3