366427615-5-7-2021-18-AS-NBRN-C2VPSQ-20210510113439

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 CARE		FACILITY NUMBER:	366427615
ADMINISTRATOR:	ADA REYES		FACILITY TYPE:	740
ADDRESS:	6206 WALNUT AVE		TELEPHONE:	(909) 548-0487
CITY:	CHINO	STATE: CA	ZIP CODE:	91710
CAPACITY:	6	CENSUS: 2	DATE:	05/07/2021
		UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Dulce Redford, Administrator		TIME COMPLETED:	08:36 AM

ALLEGATION(S):

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Stored items in facility garage pose a fire hazard

INVESTIGATION FINDINGS:

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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 Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (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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