361800187-1-4-2024-56-AS-KCLS-D6MW4C-20240627165716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800187
Report Date: 01/04/2024
Date Signed: 01/04/2024 02:04:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
12/27/2023 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231227145548

FACILITY NAME:	ROSE VALLEY REDLANDS		FACILITY NUMBER:	361800187
ADMINISTRATOR:	GLENN BERNAL		FACILITY TYPE:	740
ADDRESS:	153 S DEARBORN ST		TELEPHONE:	(909) 389-7586
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92374
CAPACITY:	6	CENSUS: 6	DATE:	01/04/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Mistie Felton, House Manager		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Staff are not properly cleaning the floors

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Mistie Felton, House Manager and discussed the purpose of the visit.

Regarding the allegation, staff are not properly cleaning the floors, LPA observed the facility floors to be clean, two (2) staff interviewed deny that the floors are not properly clean, four (4) residents interviewed stated that the facility overall is kept clean.

Based on LPA observations and interviews, the above allegation is Unsubstantiated. 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 a copy was provided to the House Manager at the conclusion of the visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
12/27/2023 and conducted by Evaluator Magda Malcore

COMPLAINT CONTROL NUMBER: 56-AS-20231227145548

FACILITY NAME:	ROSE VALLEY REDLANDS		FACILITY NUMBER:	361800187
ADMINISTRATOR:	GLENN BERNAL		FACILITY TYPE:	740
ADDRESS:	153 S DEARBORN ST		TELEPHONE:	(909) 389-7586
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92374
CAPACITY:	6	CENSUS: 6	DATE:	01/04/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Mistie Felton, House Manager		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Mistie Felton, House Manager and discussed the purpose of the visit.

Regarding the allegation, facility is in disrepair, its is alleged the facility kitchen sink, heater, and garage door is disrepair. LPA observed operating stand-alone heaters in the kitchen and dining areas. LPA observed the facility thermostat temperature was 72 degrees F. LPA spoke with Licensee Nick Vermani who stated that the facility has two main heaters. One heater is working and the other heater has not been working for two weeks. The Licensee stated that a service company did go to the facility to service the heater but were not able to fix the heater due to parts needed to be ordered. The Licensee stated that residents were provided with individual’s heaters temporarily until parts arrive. Licensee stated that a service company was contacted for garage door repair due to the door not opening properly. Licensee stated that a repairman will be at the facility today to complete garage repair. LPA conducted a tour of the kitchen. LPA observed missing tile pieces and loose tile pieces around the kitchen sink exposing rock and gravel.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 56-AS-20231227145548

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ROSE VALLEY REDLANDS	FACILITY NUMBER: 361800187
	VISIT DATE: 01/04/2024

NARRATIVE

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LPA conducted a tour of resident’s bedrooms. LPA observed a broken glass window in resident #1 (R1’s) bedroom.
Based on LPA observations, the allegation is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where reports LIC9099/LIC9099-C/ LIC9099-D were discussed. A copy of the reports with Appeal Rights were provided to the House Manager at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 56-AS-20231227145548

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ROSE VALLEY REDLANDS	FACILITY NUMBER: 361800187
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/04/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/26/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	(a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee shall submit to the licensing agency proof of repairs or a self-certification that repairs have been made by POC due date.
	8 9 10 11 12 13 14	LPA observed missing tile pieces and loose tile pieces around the kitchen sink exposing rock and gravel. LPA conducted a toured of resident’s bedrooms. LPA observed a broken glass window in resident #1 (R1’s) bedroom; which poses a potential health, safety, or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC9099 (FAS) - (06/04)

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