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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366427615
Report Date: 05/07/2021
Date Signed: 05/07/2021 11:46:09 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
04/26/2021 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210426091730
FACILITY NAME:GARDEN VILLE HOME CAREFACILITY NUMBER:
366427615
ADMINISTRATOR:ADA REYESFACILITY TYPE:
740
ADDRESS:6206 WALNUT AVETELEPHONE:
(909) 548-0487
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:6CENSUS: 2DATE:
05/07/2021
UNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Dulce Redford, AdministratorTIME COMPLETED:
08:36 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Stored items in facility garage pose a fire hazard
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Stephanie Torres, contacted the facility via telephone, due to COVID-19, for the purpose of delivering the findings of the investigation into the above allegation. The LPA identified herself and discussed the purpose of the call with Administrator, Dulce Redford.

It was alleged the Licensee had stored a large quantity of items in the facility garage, which posed a fire hazard to the residents in care. The LPA initiated the investigation, on 04/27/2021, by conducting a tour of the home and inspecting the garage. At the time of the visit, the LPA observed the Administrator to be removing items from the garage via a clutter removal company. An inspection from the local fire department, on May 03, 2021, revealed there to be no significant fire hazard. Therefore, due to the items being removed from the garage prior to inspection, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator, Redford, in which this report was reviewed, and a copy provided. Signature obtained.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
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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