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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366427615
Report Date: 12/10/2024
Date Signed: 12/10/2024 03:23:03 PM

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
12/09/2024 and conducted by Evaluator Javier Prieto
COMPLAINT CONTROL NUMBER: 56-AS-20241209082613
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: 5DATE:
12/10/2024
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Dulce Redford, LicenseeTIME COMPLETED:
03:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff leaves resident in bed for extended periods of time.
Staff cannot meet resident's needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to conduct a complaint investigation regarding the aforementioned allegations. LPA Prieto met with Licensee Dulce Redford and explained the elements of the complaint.
Allegation #1: LPA Prieto interviewed residents R1, R2, R3, R4, and R5. All residents confirmed that staff does not leave them in their beds for extended periods of time unless they are diagnosed as bedridden. R1, the resident in question, stated that she is unable to stand or walk and that staff are providing adequate care. R1's needs and services plan indicates that she requires continuous bed care.
Allegation #2: LPA Prieto interviewed residents R1, R2, R3, R4, and R5. All residents affirmed that staff are meeting their needs. R1 confirmed that her needs are being met by the staff. Based on the information obtained, there is insufficient evidence to support the allegations that staff leave residents in bed for extended periods of time and that staff cannot meet residents' needs. Therefore, these allegations are deemed UNSUBSTANTIATED at this time.
This report was signed by LPA Prieto and Licensee Redford, and a copy was left with the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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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