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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366405765
Report Date: 12/23/2025
Date Signed: 12/23/2025 12:11:12 PM

Substantiated


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
08/07/2025 and conducted by Evaluator Becky Mann
COMPLAINT CONTROL NUMBER: 56-AS-20250807150128
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: 31DATE:
12/23/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:J. Rosa Tucker, Program DirectorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff did not ensure sharp knives were kept locked and inaccessible to clients in care.
Staff did not report incident(s) to Licensing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA met with J. Rosa Tucker, Program Director and explained the purpose of the visit. The investigation consisted of LPA pertinent record reviews, observations and interviews with staff and clients.

The allegation that staff did not ensure sharp knives were kept locked and inaccessible to clients in care. LPA interviewed Staff #1 (S1) they stated that Client #1 (C1) who has a 1 to 1 at all times was left unattended by Staff #2 (S2) and C1 was able to access a knife in the kitchen. LPA interviewed Client #1 (C1) they stated that their 1 to 1 staff left them in the dining area and C1 was able to access the knife due to it not being locked away.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
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 3
Control Number 56-AS-20250807150128
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: CASA COLINA CENTERS FOR REHABILITATION/PADUA VILLA
FACILITY NUMBER: 366405765
VISIT DATE: 12/23/2025
NARRATIVE
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The allegation that staff did not report incident(s) to Licensing. LPA interviewed Staff #3 (S3) they stated that they have not reported the incident with C1 to Licensing yet. Based on LPA observations, interviews and record reviews, S3 has not reported the incident within 7 days of occurrence. The incident happened on 08/01/2025. The Special Incident Report (SIR) was submitted to Licensing on 08/13/2025.

Based on LPA observations, interviews and records review, the above allegation is Substantiated. A determination that the complaint is substantiated means that the allegation is/are valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where this report, appeal rights and LIC9099D page was reviewed and provided to J. Rosa Tucker, Program Director.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20250807150128
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: CASA COLINA CENTERS FOR REHABILITATION/PADUA VILLA
FACILITY NUMBER: 366405765
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/23/2025
Section Cited
CCR
87309(b)
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87309(b), the licensee shall ensure that disinfectants, cleaning solutions, knives, tools, sharp objects, and other similar items which could pose a danger to client are in locked storage and are not left unattended if outside the locked storage.
This requirement is not met as evidenced:
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Licensee installed a lock on the cabinet in the kitchen area to ensure that the clients do not have access to the sharps. On 8/4/2025, Licensee trained staff about the safety of keeping sharps away from the clients.
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Based on LPA interviews and record reviews, the licensee did not comply with the section cited above due to Client #1 (C1) having access to the knife in the kitchen area which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
12/23/2025
Section Cited
CCR
87211(a)(1)(D)
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87211(a) licensee shall furnish licensing agency.. reports.. require, including not limited (1) written report submitted licensing within 7 days occurrence any events, (D) Any incident threatens the welfare, safety or health of any resident. Requirement is not met as evidenced:
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Licensee stated that they will submit Special Incident Reports (SIR) within 7 days of the occurrence.
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Based on LPA interviews, observations and record reviews, Licensee did not comply with the section cited above by not reporting to CCL within 7 days of incident which poses a potential health, safety or personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3