336424105-6-17-2025-56-AS-EMAN-DJWPVK-20250725113917

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336424105
Report Date: 06/16/2025
Date Signed: 06/17/2025 08:12:33 AM

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
10/26/2022 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221026112756

FACILITY NAME:	VALENCIA TERRACE		FACILITY NUMBER:	336424105
ADMINISTRATOR:	PENDING		FACILITY TYPE:	740
ADDRESS:	2300 SOUTH MAIN STREET		TELEPHONE:	(951) 273-1300
CITY:	CORONA	STATE: CA	ZIP CODE:	92882
CAPACITY:	84	CENSUS: 68	DATE:	06/16/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Administrator - Edgar Gallardo		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff left resident in soiled diapers causing resident to sustain a rash.
Staff not administering residents medication as prescribed.
Staff not keeping an accurate medical log for residents.
Staff administering residents medication without approval of dosage(s).

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with Administrator Edgar Gallardo and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, record review and facility tour.

For the allegation, Staff left resident in soiled diapers causing resident to sustain a rash.

During residents’ interviews 9 out of the 9 residents stated they do not have a diaper rash. During staff interviews 6 out of the 6 staff stated they are responsible to change their resident’s brief every two hours. In addition, 6 out of the 6 staff stated the facility does not have a resident with a diaper rash. During record review, LPA obsevred no resident sustain a diaper rash.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025

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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Control Number 56-AS-20221026112756

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: VALENCIA TERRACE	FACILITY NUMBER: 336424105
	VISIT DATE: 06/16/2025

NARRATIVE

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For the allegation, Staff not administering residents’ medication as prescribed.

During resident interviews, 9 out of the 9 residents stated they receive all their prescribed medication.During staff interviews, 6 out of the 6 staff stated all resident's medication is administrated. During medication audit, LPA Rico observed the medication to be dispensed properly.

For the allegation, Staff not keeping an accurate medical log for residents.

During staff interviews, 6 out of the 6 staff stated no mistake as been made on resident’s medication log. During medication audit, LPA verify resident’s medication were dispensed and documented properly.

For the allegation, Staff administering residents’ medication without approval of dosage(s).

During staff interviews 6 out of 6 staff stated they have not change resident’s medication dosage. In addition, 6 out of the 6 staff stated they follow resident’s physician orders. During medication audit, LPA verify resident’s physician order matched resident’s medication logged.

Based on the evidence found during the investigation, the four (4) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Edgar Gallardo.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025

LIC9099 (FAS) - (06/04)

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