361800187-6-12-2024-56-AS-KCLS-D6MW4B-20240627165716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800187
Report Date: 06/12/2024
Date Signed: 06/12/2024 09:37:47 AM

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:	06/12/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Mistie Felton, House Manager		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Staff are mismanaging resident's medication
Staff are engaging in inappropriate behaviors in the presence of residents
Staff did not keep resident's personal information confidential

INVESTIGATION FINDINGS:

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

Regarding the allegation, staff are mismanaging resident's medication, staff interviewed deny mismanaging resident’s medications. Four (4) out of five (5) residents interviewed deny that staff have mismanaged their medications.
Regarding the allegation, staff are engaging in inappropriate behaviors in the presence of residents, staff interviewed deny engaging in inappropriate behaviors in the presence of residents. Four (4) out of five (5) residents interviewed deny that staff are engaging in inappropriate behaviors in their presence.
Regarding the allegation, staff did not keep resident's personal information confidential, staff interviewed deny not keeping resident’s personal information confidential. Four (4) out of five (5) residents interviewed deny that staff do not keep their personal information confidential.

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: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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 4

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: 06/12/2024

NARRATIVE

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Based on LPA observations and interviews with residents and staff, the allegations are Unsubstantiated. An unsubstantiated finding means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.
An exit interview was conducted where this report was discussed and a copy with Appeal Rights was provided to the House manager, Felton 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: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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:	06/12/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Mistie Felton, House Manager		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Facility has pests

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to deliver the findings on the above allegation. LPA met with House Manager, Mistie Felton, and discussed the purpose of the visit.
Regarding the allegation, facility has pests, staff interviews reveal that a resident found mice in the facility and the resident was provided money to buy the mice traps. No outside pest control services were obtained. Staff #1 (S1) stated they did see mice droppings in the facility.
Based on LPA observations and interviews with residents and staff, the above 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.
A deficiency is being cited in accordance with the California Code of Regulations, Title 22. Civil penalties will continue to accrue $100 per day until proof of correction has been received.
An exit interview was conducted where reports (LIC9099 & LIC9099-D) were discussed and provided with Appeal Rights to House Manager Felton at the conclusion of the visit.

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: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

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: 06/12/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/13/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Licensee/Administrator shall submit to the Licensing Agency proof of pest control services contracted by 6/13/2024 and submit documentation completed services by 6/18/2024.
	8 9 10 11 12 13 14	The licensee did not comply with the section cited above by not obtaining outside pest control services to ensure the facility was free of mice, 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: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4