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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880886
Report Date: 10/07/2023
Date Signed: 10/07/2023 12:34:24 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
10/19/2022 and conducted by Evaluator Amber Coleman
COMPLAINT CONTROL NUMBER: 56-AS-20221019111438
FACILITY NAME:GARDEN OF EDEN ASSISTED LIVINGFACILITY NUMBER:
361880886
ADMINISTRATOR:VELAZQUEZ, JESSICA AFACILITY TYPE:
740
ADDRESS:14383 CHAMBERLAIN DRTELEPHONE:
(442) 242-7702
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY:6CENSUS: DATE:
10/07/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:TIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
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8
9
Staff are over using physical and psychotropic restraints.
Residents with cognitive impairments are signing their own consent and required forms.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This unannounced visit by Licensing Program Analyst (LPA) Amber Coleman and Amy Goldenberg is being conducted to further investigate the above mentioned complaint allegations. During the course of the investigation, interviews were conducted with staff and residents, a review of staff records, review of resident charts, and copies of the pertinent documents was obtained. In regard to the allegation staff are over using physical and psychological physical restraints. Review of medication, medication logs and tour of the physical plant. LPA's observed no behavioral restraints by use of medication or physical restraints. It was alleged that resident's bedrails are being used as restraints. During tour, LPA observed no resident with full bed rails. It is alleged that resident's with cognitive impairments are signing their own consent forms. LPA reviewed 5 of 5 physician's reports. 5 of 5 resident records do not indicate conservatory status or a diagnosis that would prevent them from making their own decisions.

We have found the compliant allegations is unsubstantiated, although the allegations may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to Rosa Santos, Administrator
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber ColemanTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2023
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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