361880646-4-28-2021-18-AS-EMAN-C2KKGD-20210430075322

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880646
Report Date: 04/16/2021
Date Signed: 04/28/2021 09:04:25 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/11/2020 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200811103230

FACILITY NAME:	WHISPERING WINDS OF APPLE VALLEY ASSISTED LIVING		FACILITY NUMBER:	361880646
ADMINISTRATOR:	CYNTHIA EDWARDS		FACILITY TYPE:	740
ADDRESS:	11825 APPLE VALLEY ROAD		TELEPHONE:	(760) 961-1212
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92308
CAPACITY:	115	CENSUS: 66	DATE:	04/16/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Monya Henry		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Food service is inadequate.
Facility is not adhering to the Admissions Agreement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Williams contacted the facility in order to deliver findings for the above allegation. LPA contacted the facility via telephone due to the COVID-19 pandemic. LPA spoke with Administrator, Monya Henry, and discussed the purpose of the call. The investigation consisted of interviews and records review.

In regards to allegation #1, LPA interviewed Staff #1 (S1) who stated that they have not received any complaints of the food service. LPA interviewed Staff #2 (S2) who stated that they have had residents complain to them that the food was "too tough." LPA interviewed Resident #1 (R1) who stated that they had no concerns with the facility's food service. LPA interviewed Resident #2 (R2) and Resident #3 (R3) who stated that at times, the food may be undercooked/overcooked. Due to conflicting interviewee statements and lack of evidence to corroborate the allegation, LPA has determined that the allegation is UNSUBSTANTIATED.

In regards to allegation #2, LPA interviewed Staff #3 (S3) who stated that a $100 service fee would be

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

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

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20200811103230

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WHISPERING WINDS OF APPLE VALLEY ASSISTED LIVING	FACILITY NUMBER: 361880646
	VISIT DATE: 04/16/2021

NARRATIVE

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implemented to cover personal protective equipment costs. S3 stated that the fee was not added to the residents basic rent fees and a sixty day prior written notice was provided to authorized representatives. Although a written notice was provided, the facility has since recanted and are no longer charging for increased service fees, according to S1. LPA determined there was not enough evidence to meet the
preponderance of evidence standard; therefore, the allegation is UNSUBSTANTIATED.

Based on evidence obtained during today’s visit, LPA has determined that the above allegations are UNSUBSTANTIATED; meaning 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 (LIC 9099 &LIC 9099C) were discussed and a copy was provided to Henry via email.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

LIC9099 (FAS) - (06/04)

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