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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426710
Report Date: 05/13/2025
Date Signed: 05/13/2025 01:11:17 PM

Substantiated


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
05/06/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20250506142250
FACILITY NAME:LINDA VALLEY ASSISTED LIVINGFACILITY NUMBER:
366426710
ADMINISTRATOR:EILEEN SANCHEZFACILITY TYPE:
740
ADDRESS:25393 COLE ST.TELEPHONE:
(909) 799-3117
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:64CENSUS: 49DATE:
05/13/2025
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Executive Director Eileen SanchezTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility is in disrepair (carpet)
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarina Ramirez made an unannounced visit to the facility to conduct a complaint investigation on the above complaint allegation. LPA met with Executive Director Eileen Sanchez, and discussed the purpose of the visit.

Regarding the allegation, Facility is in disrepair, it was alleged the facility's second floor carpet was lifting and causing a fall hazard. LPA observed the second floor carpet and it is lifting throughout the entire hallway. The Executive Director stated that a maintenance person will be at the facility on 5/19/25 to replace the carpet with hard flooring.

Based on observation and interviews, the allegation is Substantiated. Substantiated meaning that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to Executive Director Eileen Sanchez at the conclusion of the visit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
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-20250506142250
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: LINDA VALLEY ASSISTED LIVING
FACILITY NUMBER: 366426710
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2025
Section Cited
CCR
87303(a)
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87303(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors..this requirement is not met as evidenced by:
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The executive director stated a technician would be coming to facility on 5/19/25 and should take about two days to replace. The Executive Director agreed to submit proof of repairs to the licensing agency by POC due date.
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The Licensee did not comply with the section cited above by not ensuring the lifted carpet was repaired; which poses a potential health, safety, and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2