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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366405765
Report Date: 12/17/2024
Date Signed: 12/17/2024 02:32:17 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
06/11/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240611085706
FACILITY NAME:CASA COLINA CENTERS FOR REHABILITATION/PADUA VILLAFACILITY NUMBER:
366405765
ADMINISTRATOR:STEPHANIE E. KAPLANFACILITY TYPE:
735
ADDRESS:22200 HIGHWAY 18TELEPHONE:
(760) 247-7711
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:54CENSUS: 33DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Residential Manager - Dorris MooreTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff mismanaged resident's medication
Staff did not ensure that facility was kept free of infestation
Staff did not ensure that facility was kept in good repair
Staff did not provide a safe and comfortable environment for residents
Staff did not provide a comfortable temperature for residents
Facility is malodorous
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with staff Pamala Player and Dorris Moore to explain the purpose of the visit. The investigation consisted of staff interviews, client interviews and record review. LPA Rico conducted (6) staff interviews and (6) client interviews.

For the allegation, Staff mismanaged resident's medication.

During staff interviews 6 out 6 staff stated they have not mismanaged resident medications. During resident interviews, 6 out of the 6 residents stated they receive their medications. During medication audit, LPA verify medications were dispensed properly.

For the allegation, Staff did not ensure that facility was kept free of infestation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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 56-AS-20240611085706
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CASA COLINA CENTERS FOR REHABILITATION/PADUA VILLA
FACILITY NUMBER: 366405765
VISIT DATE: 12/17/2024
NARRATIVE
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During staff interviews, 6 out 6 staff stated they have not seen rats, bugs, or any insects inside the facility. During residents’ interviews 6 out of the 6 residents stated they have not seen rats, bugs, or any insects inside the facility. In addition, 2 out of the 6 residents stated they have seen water bugs outside facility. During facility tour, LPA Rico did not see rats, bugs, or any insects inside the facility. During record review, LPA observed facility receives pest control services.

For the allegation, Staff did not ensure that facility was kept in good repair.

During staff interviews, 6 out of the 6 staff stated they have not observed something broken at the facility. In addition, 6 out of the 6 staff stated the AC unit is working and has not been broken. During resident interviews, 6 out of the 6 residents stated their AC unit is working. In addition, 6 out of the 6 residents stated staff members will repair any damages inside their room. During facility tour, LPA observed AC unit to be working.

For the allegation, Staff did not provide a safe and comfortable environment for residents.

During staff interviews, 6 out of the 6 staff stated they provide a comfortable environment for residents in care. During resident interviews, 6 out of the 6 residents stated they feel safe and comfortable at the facility.

For the allegation, Staff did not provide a comfortable temperature for residents.

During staff interviews, 6 out of the 6 staff stated they ensure the facility temperature is comfortable for all residents. 6 out of the 6 residents stated the facility temperature is comfortable. In addition, 6 out of the 6 residents stated they are allowed to change the temperature in their room.

For the allegation, Facility is malodorous.

During staff interviews, 6 out of the 6 staff interviews stated the facility is not malodorous. In addition, 6 out of the 6 staff stated they will clean resident's rooms throughout the day. During resident interviews, 6 out of the 6 residents stated the facility is not malodorous.

Based on the evidence found during the investigation, the six (6) 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 was conducted, and this report (LIC9099) was discussed and provided to Residential Manager Dorris Moore.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2