<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366405765
Report Date: 12/17/2024
Date Signed: 11/24/2025 11:59:08 AM

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
06/18/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240618153553
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:Administrator Rosa TuckerTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not assisting client with toileting needs.
Client was left on floor for hours due to lack of supervision.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst(LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA conducted a phone interview with Administrator Rosa Tucker to explained the purpose of the report. 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 are not assisting client with toileting needs.

During staff interviews 6 out of the 6 staff stated they assist with client toileting needs. In addition, 6 out of the 6 staff stated that majority of the clients are independent with toileting needs. 4 out of the 6 staff stated they change C1 every two hours, or as needed.
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)
Page: 1 of 2
Control Number 56-AS-20240618153553
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During client interviews 3 out of the 6 clients stated they do not require assistance with their toileting needs. In addition, 3 out of the 6 clients stated staff assist with their toileting needs and have not been denied for assistance. Furthermore, all clients stated they use their pendant to call staff for assistance. LPA Rico observed pendants to be working.

For the allegation, Client was left on floor for hours due to lack of supervision.

During staff interviews, 6 out of the 6 staff stated they have never left a client on the floor for an extended period of time due to lack of supervision. In addition, 3 out of the 6 staff stated that C1 was found the floor, they also reported that C1 was assisted and the proper protocol was followed.

During client interviews, 6 out of the 6 staff stated they have not been left on the floor for a long period of time. Furthermore, C1 stated they were trying to use their walker when they had a fall. C1 also stated that staff had immediately came to assist.

During facility tour, LPA Rico tested clients’ pendants. All pendants were observed to be working. During record review, LPA observed sufficient staff schedule to meet client’s needs.

Based on the evidence found during the investigation, the two (2) 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 Administrator Rosa Tucker.LPA Rico emailed a copy of the report to the Administrator for signature and requested that the signed copy be returned via email. The Administrator agreed to provide the signature and email the signed report back to Community Care Licensing.

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