366423474-8-21-2024-56-AS-EMAN-DC8NP4-20241223093742

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366423474
Report Date: 08/21/2024
Date Signed: 08/21/2024 04:29:51 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
04/25/2024 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240425152323

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: 37	DATE:	08/21/2024
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Kimberly Jordan		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff did not assist resident with showers.
Staff did not return resident's personnel property.
Facility did not issue a refund to resident per the admission's agreement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Kimberly Jordan and explained the purpose of the visit. The investigation consisted of staff interviews, client interviews and record review.

For the allegation, Staff did not assist resident with showers.

During staff interviews, 6 out of the 6 staff stated they will shower their residents on their schedule dates or as needed. During resident interviews LPA Rico did not find evidence to corroborate the allegation. LPA Rico received a copy of residents schedule showers.

For the allegation staff did not return resident’s personnel property.

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: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

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-20240425152323

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: 08/21/2024

NARRATIVE

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During staff interviews, 2 out of the 6 staff informed LPA R1 personal belongings were delivered at their home on July 9 2024 . 1 out of the 6 staff stated, that S2 was the designated driver who delivered R1 belongings. S2 confirmed belongings were delivered.

For the allegation, Facility did not issue a refund to resident per the admission's agreement.

During staff interviews, S1 informed LPA that the facility had issued R1 refund on July 2024. S3 confirmed R1 POA had received refund through mailing addressed.

Based on the evidence found during the investigation, the (3) 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 to 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 Administrator Kimberly Jordan.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC9099 (FAS) - (06/04)

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