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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881019
Report Date: 07/24/2025
Date Signed: 07/24/2025 11:31:57 AM

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
12/06/2024 and conducted by Evaluator Eldin Serrano
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241206110339
FACILITY NAME:WILDWOOD CANYON VILLAFACILITY NUMBER:
361881019
ADMINISTRATOR:BARRERA, WENDYFACILITY TYPE:
740
ADDRESS:33951 COLORADO STTELEPHONE:
(909) 446-0405
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:130CENSUS: 63DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Jessica Valiente, Resident Care CoordinatorTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Staff do not ensure sick residents are properly isolating.
Staff overlooked resident's medical records resulting in staff not allowing resident to eat or drink.
Staff do not ensure resident is accorded privacy.
Staff does not ensure facility is in good repair.
INVESTIGATION FINDINGS:
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On 7/24/2025 at 10:40 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegations. LPA Serrano met with Resident Care Coordinator (RCD) Jessica Valiente to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation.

Allegation #1: Staff do not ensure sick residents are properly isolating. – Based on the interview, 6 out of 6 residents and 6 out 6 staff stated that when the resident is sick, the facility is isolating them. The resident is assessed by the medtech and if the residents have serious illness, then they send them to the hospital and let the medical professional make a decision if they are going to be confined. LPA was unable to corroborate the allegation.

Allegation #2: Staff overlooked resident's medical records resulting in staff not allowing resident to eat or drink. - Based on interviews, 6 out 6 residents and 6 out 6 staff stated that the staff gives the resident food and drink. Based on file review resident #7 (R7) was provided services from an outside source. LPA was unable to corroborate the allegation.
*** Continuation in LIC9099C ***

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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-20241206110339
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: WILDWOOD CANYON VILLA
FACILITY NUMBER: 361881019
VISIT DATE: 07/24/2025
NARRATIVE
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Allegation #3 Staff do not ensure resident is accorded privacy. - Based on interviews, 6 out 6 residents and 6 out 6 staff stated that the staff respect the residents’ privacy. LPA inspected the memory care section of the facility and observed that all the rooms have blinds. LPA was unable to corroborate the allegation.

Allegation #4 Staff does not ensure facility is in good repair. – Based on LPA’s observation the facility was recently renovated, therefore the facility is in good repair. LPA unable to corroborate the allegation.

During the investigation, LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to RCD Jessica Valiente.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2