366427615-11-13-2025-56-AS-KCLS-DNHPUJ-20251117103734

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366427615
Report Date: 04/05/2023
Date Signed: 11/13/2025 11:32:21 AM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/03/2023 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230403125422

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: 5	DATE:	04/05/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Administrator Dulce Redford		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident sustained a bruise due to staff neglect
Staff are not seeking medical attention for residents
Staff are over medicating residents
Staff left residents in diapers for extended period of time
Staff are not providing adequate food service
Staff overcharged resident for care
Staff did not safeguard residents personal belongings

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA met with Administrator Dulce Redford and explained the elements of the complaint.

Allegation #1 - LPA Prieto interviewed staff #1 (S1) and S2 who state that they have not observed any bruising on the residents in care. LPA interviewed resident #1 (R1), R2 and R3, all who state they have not sustained bruising while at the facility.

Allegation #2 - LPA Prieto interviewed S1 and S2 who state residents have not had medical issues that require medical attention. R1, R2, R3 state they have not had medical issues that require medical attention.

Allegation #3 - Documents obtained reveal the R1 and R2 are receiving their medication as prescribed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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 56-AS-20230403125422

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
, CA 92507

FACILITY NAME: GARDEN VILLE HOME CARE	FACILITY NUMBER: 366427615
	VISIT DATE: 04/05/2023

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

Allegation #4 - LPA arrived to the facility while R1 and R2 were being changed relating to incontinence care. R1 and R2 interviews reveals their incontinence cares are being met. Documents obtained reveal incontinence care items are purchased to meet their needs.

Allegation #5 - LPA observed food being served during visit to see that food served is of adequate quality and quantity. Observations by LPA shows more than an adequate amount of perishables and non perishables.

Allegation #6 - Documents obtained for R1 and R2 show that they are being charged the appropriate amount for the services provided as well as cost for incontinence care.

Allegation #7 - Interviews with R1, R2 and R3 reveal the personal belongings are safeguarded.

Based on the information obtained there is not enough evidence to substantiate the allegations made in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Administrator Dolce and a copy was left with the facility.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2