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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880517
Report Date: 02/21/2025
Date Signed: 02/21/2025 11:50:11 AM

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
09/25/2024 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20240925161927
FACILITY NAME:ROSE VALLEY REDLANDS IIFACILITY NUMBER:
361880517
ADMINISTRATOR:MARCOS, MARSIE GAYFACILITY TYPE:
740
ADDRESS:1309 FARVIEW LNTELEPHONE:
(909) 283-4894
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:9CENSUS: 6DATE:
02/21/2025
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Administrator Marsie MarcosTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Resident sustained serious injury due to staff neglect
Facility staff did not provide assistance in meeting resident's medical needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to deliver findings on the allegations mentioned above. LPA met with Administrator Marsie Marcos and explained the purpose of the visit. The Department's investigation involved interviews and records review.

The allegation alleged that a resident (R1) sustained serious injury due to staff neglect. After a comprehensive review of medical records, interviews with facility staff, outside parties, it was determined that R1 arrived at Rose Valley Redlands II on August 6, 2024, and had two reported falls subsequently. The treating Orthopedic Surgeon estimated the fracture treated on September 23, 2024, was approximately two months old, indicating it occurred before R1 placement at Rose Valley Redlands II. Therefore, it cannot be conclusively demonstrated that the fracture happened at this facility or resulted from staff neglect.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Sarina RamirezTELEPHONE: (951) 248-0307
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
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 2
Control Number 56-AS-20240925161927
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 II
FACILITY NUMBER: 361880517
VISIT DATE: 02/21/2025
NARRATIVE
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The allegation alleged Facility staff did not provide assistance in meeting resident's medical needs. Administrator clarified that R1 received care from Innovage PACE, which manages all transportation to medical appointments. It was reported that R1 sustained an elbow skin injury on September 3, 2024, after an overnight home visit. Administrator promptly contacted Innovage for medical treatment. R1 was treated on September 5, 2024. Records show that R1’s elbow fracture was diagnosed by September 9, 2024, and was seen by a Nurse Practitioner on September 19, 2024.

Therefore, the alleged allegations have been determined Unsubstantiated. Unsubstantiated; meaning that although the allegation may have happened or is 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 (LIC 9099) was discussed, and a copy was provided to Administrator Marsie Marcos.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Sarina RamirezTELEPHONE: (951) 248-0307
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2