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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881321
Report Date: 12/02/2025
Date Signed: 12/02/2025 02:17:13 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
11/20/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241120151735
FACILITY NAME:CANYON VIEW HOMEFACILITY NUMBER:
361881321
ADMINISTRATOR:VERMANI, NITINFACILITY TYPE:
740
ADDRESS:9220 OLD RANCH RDTELEPHONE:
(909) 244-0286
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:6CENSUS: 6DATE:
12/02/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:House Manager- Sandy BarrTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff consume liquor while on shift.
Staff do not have fingerprint clearance.
Staff lock facility doors to prevent residents from leaving.
Staff insert suppositories to residents in care.
Staff did not complete required trainings.
Staff facility records are falsified.
Staff did not maintain resident records.
Residents are not provided proper food service.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with House Manager Sandy Barr and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, record review and facility tour.

For the allegation, Staff consume liquor while on shift. During staff interviews, 3 out of the 3 staff stated that they do not consume liquor on the shift. During resident interviews 3 out of the 3 residents stated they have not witnessed a staff drink consuming liquor on the shift.

For the allegation, Staff do not have fingerprint clearance. During staff interviews 3 out of the 3 staff stated that all staff memebers have a fingerprint clearance. Based on record review, LPA observed all staff memebers had a criminal record clearance.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
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 6
Control Number 56-AS-20241120151735
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: CANYON VIEW HOME
FACILITY NUMBER: 361881321
VISIT DATE: 12/02/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
For the allegation, Staff lock facility doors to prevent residents from leaving. During staff interviews 3 out of the 3 staff stated they do not lock the facility to prevent residents from leaving. During resident interviews, 3 out of the residents stated they are not locked inside the facility. During facility tour, LPA Rico did not observe any locks from facility exits.

For the allegation, Staff insert suppositories to residents in care. During staff interviews 3 out of the 3 staff stated they do not have insert suppositories to residents.

For the allegation, Staff did not complete required training. During staff interviews 3 out of the 3 staff stated they have completed their required training. Based on record reviews, LPA Rico observed staff have completed their training.

For the allegation, Staff facility records are falsified. During staff interviews, 3 out of the 3 staff stated they have not falsified facility records.

For the allegation, Staff did not maintain resident records. During staff interviews 3 out of the 3 staff stated residents records are maintained inside the facility and locked. During facility tour, LPA observed resident records were kept inside the facility and locked.

For the allegation, Residents are not provided proper food service. During staff interviews, 3 out of the 3 staff stated proper food service is provided to the residents. During resident interviews, 3 out of the 3 residents had no complaints regarding their food. In addition, LPA observed the facility had proper food and a menu for each meal.

Based on the evidence found during the investigation, the eight(8) 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 House Manager Sandy Barr.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
11/20/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241120151735

FACILITY NAME:CANYON VIEW HOMEFACILITY NUMBER:
361881321
ADMINISTRATOR:VERMANI, NITINFACILITY TYPE:
740
ADDRESS:9220 OLD RANCH RDTELEPHONE:
(909) 244-0286
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:6CENSUS: 6DATE:
12/02/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:House Manager- Sandy BarrTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure resident’s diapering needs were met.
Staff did not inform resident’s physician of resident’s change of condition.
Staff did not provide adequate medication assistance to residents in care.
Staff refuse to call an ambulance for residents in care.
Staff threatened residents in care.
Staff did not ensure sufficient food items were available at the facility for residents in care.
Staff did not prevent residents from engaging in inappropriate interactions.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with House Manager Sandy Barr and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, record review and facility tour.

For the allegation, Staff did not ensure resident’s diapering needs were met. During staff interviews, 3 out of the 3 staff stated resident diapers are changed every two hours. In addition, 3 out of the 3 staff stated that residents are independent with toileting and do not require diapers. During residents’ interviews, 3 out of the 3 residents stated they do not use diapers.

For allegation, Staff did not inform residents’ physicians of resident’s change of condition. During staff interviews, 3 out of the 3 staff stated resident’ change of condition is reported to physician and responsible party.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 56-AS-20241120151735
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: CANYON VIEW HOME
FACILITY NUMBER: 361881321
VISIT DATE: 12/02/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
For the allegation, Staff did not provide adequate medication assistance to residents in care. During staff interviews 3 out of the 3 staff stated they follow resident’s medication order and document on resident’s MAR. In addition, 3 out of the 3 staff stated medication is provided to all residents. During resident interviews, 3 out of the 3 residents stated they received their medication.

For the allegation, Staff refuse to call an ambulance for residents in care. During staff interviews, 3 out of the staff stated they never denied an ambulance for a resident. During resident interviews, 3 out of the 3 residents stated staff have not refused to call an ambulance.

For the allegation, Staff threatened residents in care. During staff interviews, 3 out of the 3 staff interviews stated they have not threatened a resident. During residents’ interviews, 3 out of the 3 residents stated they have not been threatened by staff.

For the allegation, Staff did not ensure sufficient food items were available at the facility for residents in care. During staff interviews, 3 out of the 3 staff stated the facility has sufficient food available for the residents. Based on facility tour, LPA observed the facility has sufficient food available for residents.

For the allegation, Staff did not prevent residents from engaging in inappropriate interactions. During staff interviews, 3 out of the 3 staff stated no residents have engaged in inappropriate interactions. During residents’ interviews, 3 out of the 3 residents stated they have not engaged in inappropriate interactions.

Based on the evidence found during the investigation, the seven (7) 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 House Manager Sandy Barr.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
11/20/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241120151735

FACILITY NAME:CANYON VIEW HOMEFACILITY NUMBER:
361881321
ADMINISTRATOR:VERMANI, NITINFACILITY TYPE:
740
ADDRESS:9220 OLD RANCH RDTELEPHONE:
(909) 244-0286
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:6CENSUS: 6DATE:
12/02/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:House Manager- Sandy BarrTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff yelled at residents in care.
Staff did not assist residents that sustained falls.
Centrally stored medications are accessible to residents in care.
Staff do not have a fire evacuation plan at the facility.
Staff do not have an infection control plan at the facility.
Staff are not following reporting requirements.
Staff left residents unattended.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with House Manager Sandy Barr and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, record review and facility tour.

For the allegation, staff yelled at residents in care. During staff interviews, 3 out of the 3 staff stated they have not yelled at a resident. During resident interviews, 3 out of the 3 residents stated they have not yelled at residents.

For the allegation, Staff did not assist residents that sustained falls. During staff interviews, 3 out of the 3 staff stated that no residents have sustained a fall at the facility. During residents’ interviews, 3 out of the 3 residents stated they have not sustained a fall at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 56-AS-20241120151735
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: CANYON VIEW HOME
FACILITY NUMBER: 361881321
VISIT DATE: 12/02/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
For the allegation, Centrally stored medications are accessible to residents in care. During staff interviews 3 out of the 3 staff stated medication is kept locked and inaccessible to residents. During facility tour, LPA observed medications locked inside a cabinet and inaccessible to residents.

For the allegation, Staff do not have a fire evacuation plan at the facility. During staff interviews, 3 out of the 3 staff stated the facility has fire evacuation plan posted on the facility hallway and emergency supplies/ food is in the garage. During facility tour, LPA observed the facility had an updated disaster plan with the evacuation location, LPA also observed emergency food/supplies readily available.

For the allegation, Staff do not have an infection control plan at the facility. During staff interviews, 3 out of the 3 staff stated the facility has an infection control plan. During record review, LPA Rico observed the facility had an updated infection control plan.

For the allegation, Staff are not following reporting requirements. During staff interviews 3 out of the 3 staff stated they follow reporting requirements.

For the allegation, Staff left residents unattended. During staff interviews, 3 out of the 3 staff do not leave residents unattended. During resident interviews, 3 out of the 3 staff stated they have not been unattended inside the facility.

Based on the evidence found during the investigation, the seven (7) 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 House Manager Sandy Barr.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6