361880646-3-11-2026-56-AS-KCLS-DSFUFE-20260323153238

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880646
Report Date: 03/11/2026
Date Signed: 03/11/2026 02:36:13 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
12/04/2024 and conducted by Evaluator Beena Singh

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20241204154507

FACILITY NAME:	WHISPERING WINDS OF APPLE VALLEY ASSISTED LIVING		FACILITY NUMBER:	361880646
ADMINISTRATOR:	JEFFERY GOLLINAR		FACILITY TYPE:	740
ADDRESS:	11825 APPLE VALLEY ROAD		TELEPHONE:	(760) 961-1212
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92308
CAPACITY:	116	CENSUS: 97	DATE:	03/11/2026
		UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Executive Director-Jeffrey Gollihar		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff allowed resident to enter a contract without resident's representative consent.
Staff transferred resident to memory care without resident's representative consent.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to deliver findings on above allegation. LPA Singh met with Executive Director-Jefferey Gollihar, facility representative, and was granted entry into the facility. The investigation conducted by LPA Singh consisted of interviews and records review.

First Allegation:Staff allowed resident to enter a contract without resident's representative consent.
LPA Singh reviewed records and R#1 can legally enter into any financial agreements when they signed the original documets on 04/11/2024,and later R#1s Responsible party-family, who is the Durable Power of Attorney (DPOA) and Successor Trustee of R#1s trust, had to sign an affidavit to change the trustee due to R#1's mental incompetence on 11/19/2024.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

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-20241204154507

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WHISPERING WINDS OF APPLE VALLEY ASSISTED LIVING	FACILITY NUMBER: 361880646
	VISIT DATE: 03/11/2026

NARRATIVE

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Second Allegation: Staff transferred resident to memory care without resident's representative consent.
As R#1s Responsible party-family, who is the Durable Power of Attorney (DPOA) and Successor Trustee of R#1s trust, had to sign an affidavit to change the trustee due to R#1's mental incompetence and signed the documents on 11/19/2024 consenting to resident to memory care.

In conclusion, based on all of the information obtained during the course of the investigation, it is
determined that R#1s Responsible party-family, who is the Durable Power of Attorney (DPOA) and Successor Trustee of R#1s trust, had to sign an affidavit to change the trustee due to R#1's mental incompetence. R#1s family who is a responsible party signed the transfer of R#1 to memory care and it is determined that these allegations are Unsubstantiated at this time.

Based on the evidence found during the investigation, the 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 with the facility representative Jeff Gollihar and provided copy of LIC LIC9099, 9099C.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC9099 (FAS) - (06/04)

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