361880646-4-1-2025-18-AS-KCLS-DGPTJR-20250515144648

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880646
Report Date: 04/01/2025
Date Signed: 04/01/2025 02:37:19 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
07/19/2021 and conducted by Evaluator Becky Mann

COMPLAINT CONTROL NUMBER: 18-AS-20210719132953

FACILITY NAME:	WHISPERING WINDS OF APPLE VALLEY ASSISTED LIVING		FACILITY NUMBER:	361880646
ADMINISTRATOR:	MONYA HENRY		FACILITY TYPE:	740
ADDRESS:	11825 APPLE VALLEY ROAD		TELEPHONE:	(760) 961-1212
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92308
CAPACITY:	116	CENSUS: 103	DATE:	04/01/2025
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Jeffrey Gollihar, Executive Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility administrator is not present in the facility an adequate amount of hours.
Lack of supervision resulting in residents wandering from the facility.
Facility is understaffed.
Facility is dirty.
Staff are not properly trained.
Staff did not administer resident medications according to physician orders.
Staff do not respond to resident(s) call buttons.
Residents needs are not being met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA Mann met with Jeffrey Gollihar, Executive Director and explained the purpose of today's visit. The investigation consisted of LPAs observations, pertinent document reviews, and interviews with staff and residents.

The allegation of facility administrator is not present in the facility an adequate amount of hours. All staff interviewed stated that facility administrator is present in the facility all the time and sometimes on the weekends. All residents interviewed stated that facility administrator is present and is there to assist when needed.

The allegation of lack of supervision resulting in residents wandering from the facility. All staff interviewed denied there being a lack of supervision at the facility and no resident has wandered from the facility. All residents interviewed stated there is no lack of supervision at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Becky Mann	TELEPHONE: 951-248-0306
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

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-20210719132953

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: 04/01/2025

NARRATIVE

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The allegation that facility is understaffed. All staff interviewed stated that the facility is fully staffed. All residents interviewed stated that facility is fully staffed and is able to get assistance at all times.

The allegation that facility is dirty. LPA toured the facility with Jeffrey Gollihar, Executive Director, the facility is clean and staff does maintain the facility by keeping up with the cleaning at all times.

The allegation is staff are not properly trained. Based on LPA observations, interviews, and record reviews, the facility staff is properly trained. Interviews conducted with facility staff, all staff have received required trainings and certifications to provide proper care for residents. Residents interviewed stated that staff is properly trained and assist residents when they need help with anything.

The allegation that staff did not administer resident medications according to physician orders. All staff interviewed stated that they do administer resident medications according to physician orders. All residents interviewed stated that staff does administer resident medications according to physician orders.

The allegation that staff do not respond to resident(s) call buttons. All staff interviewed stated that they do respond to resident's call buttons in a timely manner. All residents interviewed stated that staff does respond to resident's call buttons right away.

The allegation that residents needs are not being met. All staff interviewed stated that they do make sure that residents needs are being met. All residents interviewed stated that staff does make sure that their needs are being met.

Based on evidence obtained during the investigation, 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 was discussed, and a copy was provided to Jeffrey Gollihar, Executive Director at the conclusion of the visit.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Becky Mann	TELEPHONE: 951-248-0306
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

LIC9099 (FAS) - (06/04)

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