366423474-2-11-2022-18-AS-NBRN-CCLQMY-20220317121820

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366423474
Report Date: 02/11/2022
Date Signed: 02/11/2022 12:54:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/04/2022 and conducted by Evaluator Anna Bueno

COMPLAINT CONTROL NUMBER: 18-AS-20220204101512

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: 36	DATE:	02/11/2022
		UNANNOUNCED	TIME BEGAN:	10:58 AM
MET WITH:	Kimberly Jordan		TIME COMPLETED:	12:56 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Food served to residents is not of the quality and/or quantity necessary to meet the needs of the residents.
Raw meat is not stored in covered containers at appropriate temperatures.
Kitchen equipment is not maintained in good repair.
Facility plumbing system is in disrepair.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Anna Bueno arrived at the facility for the purpose of investigating and delivering findings for the above allegations for this complaint. LPA Bueno met with administrator Kimberly Jordan and advised of the purpose of the visit.
The investigation consisted of a tour of the kitchen and dining area, common bathroom, staff interviews, and file reviews.

Allegation 1: Food served to residents is not of the quality and/or quantity necessary to meet the needs of the residents. This facility has been following its Covid-19 mitigation plan and providing in-room meal service due to active Covid-19 cases. Allegation 2: Raw meat is not stored in covered containers at appropriate temperatures. Staff interview revealed that frozen food is left on the counter to thaw at about two hours before meal prep begins. Allegation 3: Kitchen equipment is not maintained in good repair. Interviews reveal that the facility has made arrangements to repair the kitchen equipment however the third party servicer did not return to the facility upon learning about Covid-19 positives in the facility. Allegation 4: Facility plumbing system is in disrepair. Staff interview reveal that the facility always had hot water however some bathrooms have water valves in a different order. The facility has since labeled hot and cold faucet knobs in identified bathrooms.

Based on information gathered from file reviews and interviews the above allegation is UNSUBSTANIATED. 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, therefore the allegation is unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022

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 1