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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881248
Report Date: 10/16/2024
Date Signed: 10/16/2024 04:05:24 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
05/07/2024 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240507133354
FACILITY NAME:WESTFIELD VILLA GARDENSFACILITY NUMBER:
331881248
ADMINISTRATOR:MARIA JASMIN DOLORESFACILITY TYPE:
740
ADDRESS:3863 WEST RAMSEY STTELEPHONE:
(951) 849-7521
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:50CENSUS: 34DATE:
10/16/2024
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Gemma FallsTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Staff does not ensure resident's showering needs are being met.
Staff does not provide resident adequate food service
Staff does not safeguard resident's personal belongings
Staff left resident in soiled diaper for an extended period of time

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the complaint investigation. LPA met with Supervisor, Gemma Falls and discussed the purpose of the visit. The investigation consisted of LPA record review, interviews with residents and staff.

Regarding the allegation, staff does not ensure resident's showering needs are being met, four (4) staff interviewed deny not ensuring resident's showering needs are being met. Five (5) out of (6) residents interviewed stated that their showering needs are being met.

Regarding the allegation, staff does not provide resident adequate food service, it was alleged that hot food is not served at appropriate temperatures. Four (4) staff interviewed deny that hot food is not served at appropriate temperatures. Four (4) out of (6) residents interviewed stated that hot food is served at appropriate temperatures.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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-20240507133354
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WESTFIELD VILLA GARDENS
FACILITY NUMBER: 331881248
VISIT DATE: 10/16/2024
NARRATIVE
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Regarding the allegation, staff does not safeguard resident's personal belongings, it was alleged that resident #1 (R1) had a chair cushion stolen at the facility. LPA record review, interviews with four (4) staff and six (6) residents reveals not enough evidence to corroborate the allegation.

Regarding the allegation, staff left resident in soiled diaper for an extended period of time, four (4) staff interviewed deny leaving residents in soiled diapers for an extended period of time. Five (5) out of (6) residents interviewed stated that they have not be left in soiled diapers for an extended period of time.

Based on evidence obtained during this investigation, the allegation above is Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed and a copy of this report was provided with appeal rights to Supervisor Falls at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2