366423474-12-20-2024-56-AS-KCLS-DCGA2B-20241230225004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366423474
Report Date: 12/20/2024
Date Signed: 12/20/2024 11:55:19 AM

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
11/14/2024 and conducted by Evaluator Becky Mann

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20241114101326

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: 33	DATE:	12/20/2024
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Kimberly Jordan, Administrator		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Staff hits residents
Staff verbally abuse residents
Staff are double diapering residents
Staff are not addressing the presence of rats in the facility

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 Kimberly Jordan, Administrator and explained the purpose of today's visit. The investigation consisted of LPAs observations, pertinent document reviews, and interviews with staff and residents.

The allegation that staff hits residents. All staff interviewed stated that they did not hit residents. Six (6) residents interviewed stated that they have not been hit by staff.

The allegation that staff verbally abuse residents. All staff interviewed stated that they have not verbally abuse residents. Six (6) residents stated they have not been verbally abused by staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Becky Mann	TELEPHONE: 951-248-0306
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

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-20241114101326

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: 12/20/2024

NARRATIVE

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The allegation that staff are double diapering residents. Four (4) out of five (5) staff interviewed stated that they have not double diaper residents nor have they witnessed a staff double diaper a resident. Three (3) residents interviewed stated that they were not being double diapered.

The allegation that staff are not addressing the presence of rats in the facility. Four (4) out of five (5) staffed interviewed stated that they have not seen the presence of rats in the facility. All residents interviewed stated that they have not seen rats in the facility. LPAs record review reveals that the facility has a monthly contract with an outside pest control company. LPAs toured the facility's kitchen area, resident hallways, and five (5) resident's bedrooms and did not observed any rats.

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 Kimberly Jordan at the conclusion of the visit.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Becky Mann	TELEPHONE: 951-248-0306
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

LIC9099 (FAS) - (06/04)

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