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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 01:48:48 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
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):
1
2
3
4
5
6
7
8
9
Staff did not inform resident’s physician of resident’s change of condition
Staff did not provide adequate medication assistance to residents in care
Staff refuse to call an ambulance for residents in care
Staff threatened residents in care
Staff did not ensure sufficient food items were available at the facility for residents in care
Staff did not prevent residents from engaging in inappropriate interactions
Staff yelled at residents in care
Staff did not assist residents that sustained falls
Centrally stored medications are accessible to residents in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
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 inform innovage as soon as they observe a change or condition

LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs they get assessed yearly by a physician, LPAs observed and reviewed records showing all residents have up to date physician reports.

Regarding the allegation #2 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs they provide adequate medication assistance to residents
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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32
LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs staff provide adequate medication assistance.

Regarding the allegation #3 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs staff do not refuse to call ambulance for residents in care.

LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs staff do not refuse to call ambulance for residents when ambulance services is needed.

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

LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs staff do not threaten the residents.

Regarding the allegation #5 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs staff ensure there is sufficient food items available at the facility for residents in care. 3 out of the 3 staff stated they go grocery shopping weekly.

LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs facility has sufficient food items available for all residents in care.

Regarding the allegation #6 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs there is no inappropriate interactions with residents in care at the facility.

LPA Ramirez and LPA Mann conducted 3 resident interviews. 3 out of the 3 residents informed LPAs they do not engage in inappropriate interactions with other residents.
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation #7 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs staff do not yell at residents in care.

LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs staff do not yell at residents.

Regarding the allegation #8 LPA Ramirez and LPA Mann conducted 3 staff interviews. 3 out of the 3 staff informed LPAs staff assist residents that sustain falls

LPA Ramirez and LPA Mann conducted 5 resident interviews. 5 out of the 5 residents informed LPAs they have not fallen at the facility.

Regarding the allegation #9 LPA Ramirez and LPA Mann conducted 3 staff interviews 2 out of the 3 staff stated the medication is centrally locked and inaccessible to residents in care. 1 out of the 3 staff stated they do not administer medication. LPAs observed medication is locked in a cabinet inaccessible to residents in care

Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated; meaning that although the allegation 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 a copy with appeal rights was 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