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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366423474
Report Date: 10/15/2024
Date Signed: 10/15/2024 12:20:54 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
10/09/2024 and conducted by Evaluator Becky Mann
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241009162939
FACILITY NAME:VALLEY CRESTFACILITY NUMBER:
366423474
ADMINISTRATOR:JORDAN, KIMBERLYFACILITY TYPE:
740
ADDRESS:18524 CORWIN RDTELEPHONE:
(760) 242-3188
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:65CENSUS: 35DATE:
10/15/2024
UNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Sumoya PearsonTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff restricted resident from having visitors.
Staff did not allow a resident to receive phone calls.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Becky Mann and Magda Malcore conducted an unannounced visit to the facility to initiate a complaint investigation. LPAs Mann and Malcore met with Sumoya Pearson and explained the purpose of today's visit.The investigation consisted of record reviews, interviews with staff, and residents.

In regards to allegations, staff restricted resident from having visitors and staff did not allow a resident to receive phone calls. LPAs met with three (3) staff and six (6) clients. All staff interviewed stated that they did not restrict residents from visitations and/or phone calls. Four (4) clients interviewed stated that they were not restricted from having visitations and/or phone calls.There were two (2) clients that were not able to answer due to their cognitive condition.LPAs were not able to interview resident #1 (R1) due to being deceased.


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Becky MannTELEPHONE: 951-248-0306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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-20241009162939
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: VALLEY CREST
FACILITY NUMBER: 366423474
VISIT DATE: 10/15/2024
NARRATIVE
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Based on evidence obtained during the investigation, the above allegations are Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed, and a copy was provided to Sumoya Pearson at the conclusion of the visit.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Becky MannTELEPHONE: 951-248-0306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2