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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880517
Report Date: 12/02/2025
Date Signed: 12/02/2025 08:06:50 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
03/21/2024 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20240321113158
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:
12/02/2025
UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Administrator, Marsie MarcosTIME COMPLETED:
08:15 PM
ALLEGATION(S):
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9
Staff do not maintain accurate medication records for residents

Staff do not store residents’ medication in original container

Staff do not ensure facility is free from odors
INVESTIGATION FINDINGS:
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13
On 12/02/2025 at 4:15PM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the residence in order to deliver findings for the above allegations. LPA discussed the purpose of the visit with Administrator, Marsie Marcos. The investigation consisted of interviews, record review and observation.

In regards to the allegation of staff do not maintain accurate medication records for residents:
LPA interviewed three (3) staff. LPA reviewed the Medication Administration Record(s) (MAR) for five (5) residents in care and audited medications. Staff denied the allegation. Based on interviews and record review, this allegation is UNSUBSTANTIATED.

In regards to the allegation of staff do not store residents’ medication in original container:
LPA observed all resident medication(s) to be in their original containers. Staff denied the allegation. Based upon observation and interview, this allegation is UNSUBSTANTIATED.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
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 6
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
03/21/2024 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20240321113158

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:
12/02/2025
UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Administrator, Marsie MarcosTIME COMPLETED:
08:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9

Staff hide medication in resident’s food


Staff do not ensure medication is dispensed to residents as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/02/2025 at 4:15PM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility to deliver findings for the above allegations. LPA discussed the purpose of the visit with Administrator, Marsie Marcos.

The allegation that staff hide medication in resident's food is SUBSTANTIATED.
Based on interviews with staff and a relative of Resident 1 (R1), R1 has refused medication in the past and the relative of R1 granted permission for staff to give R1 medication in their food.

The allegation that staff do not ensure medication is dispensed to residents as prescribed is SUBSTANTIATED.
Staff stated that all medication is given according to the physician's orders. LPA observed that the Medication Administration Records (MAR) for Residents 1, 2, 3 and 4 had discrepancies. LPA reviewed the MAR notes and did not observe documentation of why medication was not given.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
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 6
Control Number 56-AS-20240321113158
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: 12/02/2025
NARRATIVE
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SUBSTANTIATED is defined as the complaint allegation(s) is valid and a violation has occurred based on the preponderance of available evidence. Two deficiencies will be cited.

An exit interview was conducted where this report LIC9099A, LIC9099C, LIC9099D and Appeal Rights were discussed, and a copy was provided to Administrator, Marsie Marcos.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 56-AS-20240321113158
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/03/2025
Section Cited
CCR
87465(5)(D)
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87465 Incidental Medical and Dental Care
(5) Facility staff, except those authorized by law, shall... : (D).. does not include..., hiding or camouflaging medications in other substances... without the resident's knowledge and consent..
This requirement was not met as evidenced by:
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The Administrator will conduct a staff training on medications, review the regulations on Medication and submit proof to LPA by the Plan of Correction (POC) due date.
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Based upon interview and record review, the Administrator did not ensure that the resident exercised their right to refuse medication by hiding Resident 1 (R1's) medication in their food which poses/posed an immediate risk to health and safety of resident(s) in care.
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7
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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.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 56-AS-20240321113158
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2025
Section Cited
CCR
87465(b)(2)
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87465 Incidental Medical and Dental Care
(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need...(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by:
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The Administrator will conduct a staff training on medication and submit proof to LPA by Plan of Correction (POC) due date.
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Based on interview and record review, the Administrator did not ensure that the resident(s) in care were given their medications according to the physician's orders which posed/poses a potential risk to the health and safety of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 56-AS-20240321113158
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: 12/02/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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19
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21
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28
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In regards to the allegation of staff do not ensure facility is free from odors: LPA observed five (5) residents in care and two (2) staff assisting residents. LPA conducted a brief tour of the residence and found it to be sanitary and free from mal odors. Based upon observation, this allegation is UNSUBSTANTIATED.

UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted where this report LIC9099 and LIC9099C was discussed and copies were provided to staff.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6