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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880646
Report Date: 11/13/2024
Date Signed: 11/13/2024 01:54:30 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
11/07/2024 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241107100718
FACILITY NAME:WHISPERING WINDS OF APPLE VALLEY ASSISTED LIVINGFACILITY NUMBER:
361880646
ADMINISTRATOR:JEFFERY GOLLINARFACILITY TYPE:
740
ADDRESS:11825 APPLE VALLEY ROADTELEPHONE:
(760) 961-1212
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY:116CENSUS: 91DATE:
11/13/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jeff GolliharTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not ensure residents bathroom was cleaned properly.
Staff did not ensure resident's water container was cleaned.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to initiate a complaint investigation on the above allegations. LPA met with Executive Director, Jeff Gollihar and explained the purpose of the visit.

Regarding the allegation, staff did not ensure resident's bathroom was cleaned properly, LPA inspected six (6) resident bathrooms and observed bathroom showers and toilets were cleaned. Interviews with staff and residents reveal staff are ensuring bathrooms are maintained clean.

Regarding the allegation, staff did not ensure resident's water container was cleaned, interviews with staff and residents reveal not enough evidence that staff did not ensure resident's drinking water container was cleaned.

Based on LPA observations and interviews with pertinent parties, the above allegations are Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
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 3
Control Number 56-AS-20241107100718
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: WHISPERING WINDS OF APPLE VALLEY ASSISTED LIVING
FACILITY NUMBER: 361880646
VISIT DATE: 11/13/2024
NARRATIVE
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An Unsubstantiated finding means 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 with appeal rights was provided to the Executive Director at the conclusion of visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3