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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530162
Report Date: 10/21/2025
Date Signed: 10/21/2025 01:05:38 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
07/21/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250721135236
FACILITY NAME:FOOTHILL SERENITY LIVINGFACILITY NUMBER:
365530162
ADMINISTRATOR:GUEVARRA, MARYDESFACILITY TYPE:
735
ADDRESS:8024 REDWOOD AVETELEPHONE:
(909) 371-3967
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:32CENSUS: 24DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Facility Staff Noriel AlpaparaTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Facility did not seek medical attention in a timely manner for resident in care.
INVESTIGATION FINDINGS:
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First Allegation: Facility did not seek medical attention in a timely manner for residents in care.

Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to deliver findings on a complaint alleging neglect/lack of supervision. LPA Singh met with Facility staff Noriel Alpapara and was granted entry into the facility. The investigation conducted by Department staff consisted of interviews and reviews of pertinent records.

The complainant alleges that R#1 fell outside of the facility and staff allegedly failed to seek medical attention for the injury. Department staff investigated this complaint and found that on the evening of July 2, 2025, Resident #1 sustained a fractured right ankle after a fall. According to facility records, the resident was promptly transported to Kaiser within one hour of the incident. The following morning, resident#1 was discharged back to the facility, fitted with a fiberglass cast and crutches.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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-20250721135236
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: FOOTHILL SERENITY LIVING
FACILITY NUMBER: 365530162
VISIT DATE: 10/21/2025
NARRATIVE
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Following the injury, Resident #1 attended two scheduled follow-up visits with the primary care physician on July 7, 2025, and again on July 10, 2025. During both visits, the resident did not report any concerns regarding the injured right ankle.

The resident was subsequently seen by an orthopedic specialist on July 17, 2025. At this appointment, Resident #1 again did not complain of pain, and staff observed no visible signs that the ankle injury was worsening.

Therefore, based on the evidence gathered during the investigation, the allegations listed above is deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations 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 deficiency were cited per Title 22 of the California Code of Regulations.

An exit interview was conducted, and a copy of this report, LIC9099,LIC 9099C were discussed and provided to Facility Staff Noriel Alpapara.

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

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2