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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880646
Report Date: 03/11/2026
Date Signed: 03/11/2026 02:27:49 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
04/24/2024 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240424141448
FACILITY NAME:WHISPERING WINDS OF APPLE VALLEY ASSISTED LIVINGFACILITY NUMBER:
361880646
ADMINISTRATOR:JEFFERY GOLLINARFACILITY TYPE:
740
ADDRESS:11825 APPLE VALLEY ROADTELEPHONE:
(760) 961-1212
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY:116CENSUS: 97DATE:
03/11/2026
UNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Executive Director-Jeffrey GolliharTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Staff did not dispense medication to resident as prescribed.
Staff did not address a change in resident’s condition in a timely manner.
Staff did not notify resident’s responsible party of a meeting regarding a change in resident’s condition.
Staff did not maintain a completed care plan for resident.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to deliver findings on above allegation. LPA Singh met with Executive Director-Jefferey Gollihar, facility representative, and was granted entry into the facility. The investigation conducted by LPA Singh consisted of interviews and records review.

First Allegation:-Staff did not dispense medication to resident as prescribed.
Resident#1 was under Hospice care and medication was prescribed by their physician and been updated accordingly. LPA Singh reviewed records, interviewed nurse director who stated all staff follow the hospice care plan if residents are on hospice or by the physician order. Staff contact responsible party to notify any changes in medication. Five (5) out of Five(5) residents stated they have been given medications according to prescriptions.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026
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-20240424141448
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: WHISPERING WINDS OF APPLE VALLEY ASSISTED LIVING
FACILITY NUMBER: 361880646
VISIT DATE: 03/11/2026
NARRATIVE
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Second Allegation: Resident has unexplained bruises due to lack of supervision.
According to five(5) out of five(5) residents stated facility staff looks after them and ensures that all the residents are safe and being cared for. LPA Singh reviewed records and interviewed staff who stated that residents facility takes immediate measures if residents needed any emergency services and reported to relevant parties.

Third Allegation: Staff did not notify authorized representative of change in residents condition.
LPA Singh reviewed records and according to facility documentation facility staff did inform authorized representative of change in condition. Five(5) out of Five(5) residents stated that staff do notify any changes or meeting takes place at the facility regarding the residents change of condition or any matter related to the residents well being.

Fourth Allegation: Staff did not maintain a completed care plan for resident.
During the investigation, Licensing Program Analyst (LPA) Singh interviewed a Staff Nurse regarding the care protocols for residents under hospice care. The Staff Nurse confirmed that all hospice residents have a dedicated hospice care plan. Additionally, the facility maintains the required 602A assessments and "Needs and Services" plans for these individuals. Staff members ensure that the daily needs of all residents are consistently met and that these actions are properly documented. LPA Singh conducted a specific review of Resident #1’s records, which verified that the daily needs of Resident #1 have been thoroughly documented.
Based on the information gathered, LPA Singh was not able to find sufficient evidence to corroborate the allegations listed above.

Based on the evidence found during the investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview has been conducted and copy of this report has been provided to Executive Director Jeff Gollihar.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2