<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426710
Report Date: 08/14/2020
Date Signed: 08/18/2020 09:32:04 AM



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
08/13/2020 and conducted by Evaluator Naisha Kendrix
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200813165138
FACILITY NAME:LINDA VALLEY ASSISTED LIVINGFACILITY NUMBER:
366426710
ADMINISTRATOR:BROOKE ABREGOFACILITY TYPE:
740
ADDRESS:25393 COLE ST.TELEPHONE:
(909) 799-3117
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:64CENSUS: 56DATE:
08/14/2020
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Brooke AbregoTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Illegal eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Due to the Department’s implementation, and in following current public health guidance, this report will be delivered via tele-visit. Licensing Program Analyst (LPA) Naisha Kendrix identified herself to the Administrator, Brooke Abrego, and stated the reason for the tele-visit was to tour the facility and deliver the finding for the above allegation.

LPA conducted three (3) interviews with family, staff, and the reporting party (RP) regarding the allegation. An interview with the RP alleged that the facility illegally evicted resident one (R1) bases on the facility failed to accept R1 back after testing positive for COVID. Two (2 ) of the three (3) interviews conducted indicate R1 was not evicted but was admitted to a Skilled Nursing Facility (SNF) until the 10-day quarantine was completed per the San Bernardino Department Public Health. The facility was unable to isolate R1 but did assist the family to arrange placement tot he SNF.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Edna MusokeTELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Naisha KendrixTELEPHONE: (951) 204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2020
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 18-AS-20200813165138
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: LINDA VALLEY ASSISTED LIVING
FACILITY NUMBER: 366426710
VISIT DATE: 08/14/2020
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
The administrator stated R1 will be returning to the facility as of Monday, August 17, 2020.

This agency has investigated the complaint alleging an illegal eviction of a resident. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted via tele-visit where this report was reviewed then provided to the administrator. The administrator will return the signed reports within 24 hours of receipt.
SUPERVISOR'S NAME: Edna MusokeTELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Naisha KendrixTELEPHONE: (951) 204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2