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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881019
Report Date: 07/24/2025
Date Signed: 07/24/2025 11:14:26 AM

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
12/05/2024 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20241205093157
FACILITY NAME:WILDWOOD CANYON VILLAFACILITY NUMBER:
361881019
ADMINISTRATOR:BARRERA, WENDYFACILITY TYPE:
740
ADDRESS:33951 COLORADO STTELEPHONE:
(909) 446-0405
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:130CENSUS: 63DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Jessica Valiente, Resident Care CoordinatorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff did not assist a resident's call button in a timely manner
Staff do not provide residents with housekeeping services
Staff do not ensure that the facility is maintained sanitary
Facility is malodorous
Licensee does not ensure that staff receives required training
INVESTIGATION FINDINGS:
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On 7/24/2025 at 10:40 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegations. LPA Serrano met with Resident Care Coordinator (RCD) Jessica Valiente to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation.

Allegation #1: Staff did not assist a resident's call button in a timely manner – Based on observation LPA tested one of the resident’s call buttons and one of the staff came to the room to check the resident within 2 minutes. Based on the interview, 6 out of 6 residents and 6 out 6 staff stated that when the call button was pressed the care partners would come right away, whoever staff that is available will come to check the residents. LPA was unable to corroborate the allegation.

Allegation #2: Staff do not provide residents with housekeeping services - Based on file review and interviews, 6 out 6 residents and 6 out 6 staff stated that the housekeeping cleans their room and changes bedding once a week on schedule. The facility also provided the housekeeping schedule. LPA was unable to corroborate the allegation.

*** Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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 2
Control Number 56-AS-20241205093157
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: WILDWOOD CANYON VILLA
FACILITY NUMBER: 361881019
VISIT DATE: 07/24/2025
NARRATIVE
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Allegation #3 Staff do not ensure that the facility is maintained sanitary - Based on interviews, information received during the investigation did not corroborate with the allegation. Based on LPA's observation the facility was recently renovated, and the facility is clean and sanitary all through out.

Allegation #4 Facility is malodorous – Based on interviews, information received during the investigation did not corroborate with the allegation. Based on LPA’s observation the facility does not have a foul odor or bad smell.

Allegation #5 Licensee does not ensure that staff receives required training – Based on file review and interviews, 6 out 6 staff indicated that every staff is trained before they start working at the facility. Facility provided the certificate of completion of all the medtech’s training including staff #7 (S7) training certificate. LPA was unable to corroborate the allegation.

During the investigation, LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to RCD Jessica Valiente.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2