366423474-12-27-2023-56-AS-EMAN-D3BU3X-20240313151416

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366423474
Report Date: 12/27/2023
Date Signed: 12/27/2023 11:33:28 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
09/25/2023 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230925091606

FACILITY NAME:	VALLEY CREST		FACILITY NUMBER:	366423474
ADMINISTRATOR:	JORDAN, KIMBERLY		FACILITY TYPE:	740
ADDRESS:	18524 CORWIN RD		TELEPHONE:	(760) 242-3188
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92307
CAPACITY:	65	CENSUS: 40	DATE:	12/27/2023
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Business Office Manager Valerie Hammond		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not isolate resident with contagious disease
Unqualified staff providing medicine to residents
Staff are not properly caring for resident's pressure injury
Staff are not meeting residents restroom needs
Staff are not buying enough diapering supplies for residents
Facility has pests

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 deliver findings on the allegations listed above. LPA met with Business Office Manager Valerie Hammond and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, document reviews, and facility tour.

For the allegation, Staff did not isolate resident with contagious disease.
During staff interview, all staff informed LPA the facility has isolated residentS with a contagious disease. All staff informed LPA that the facility provides PPE and equipment to wear when someone tests positive for COVID or any contagious disease. In addition, all staff informed LPA the facility will isolate the residents when someone tests positive.

For the allegation, unqualifies staff providing medicine to residents

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

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-20230925091606

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: VALLEY CREST	FACILITY NUMBER: 366423474
	VISIT DATE: 12/27/2023

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 staff interviews, all staff informed LPA they have not witness a team member provide medicine to residents who is not trained. Administrator informed LPA the facility has staff members who are specifically trained to pass medications. Administrator also informed LPA the facility provides annual training for all team members. During record review, LPA observed all staff training and med-tech training.

For the allegation, Staff are not properly caring for resident's pressure injury. During interview with staff, all staff informed LPA that R1 is receiving hospice care for their pressure injury, and they do not provide care for the pressure injury. All staff informed LPA that they would notify hospice if any changes are needed. During record review, LPA confirmed R1 is receiving hospice care for their pressure injury and additional care.

For the allegation, Staff are not meeting resident’s restroom needs. During interview with residents, all residents informed LPA they receive assistance to the restroom when needed. During interview with staff, all staff informed LPA they change their residents every three hours or as needed per residents’ request. S1 informed LPA before the shift ends every team member is required to check their residents before leaving their shift.

For the allegation, Staff are not buying enough diapering supplies for residents. During interviews with staff, all staff informed LPA the facility provides enough diapering supplies for the residents. All staff informed LPA some residents also receive their supplies from hospice. S1 informed LPA the facility has two storages for resident supplies .During facility tour, LPA observed both storages stocked with residents’ supplies. LPA also observed supplies in residents’ rooms. During record review, LPA confirmed facility has been ordering supplies for residents.

For allegation, Facility has pests. During interview with staff, all staff informed LPA they have not observed pests at the facility. Administrator informed LPA the facility has a pest company come to the facility once a month. During interview with residents, all resident informed LPA they have not witness any pest at the facility. During record review, LPA noted the facility receives pest control once a month. During facility tour, LPA did not observed pest at the facility.

Based on the evidence found during the investigation, the six (6) allegation 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 was discussed and provided to Business Office Manager Valerie Hammond.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2