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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530263
Report Date: 04/01/2025
Date Signed: 04/29/2025 10:37:48 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
02/20/2025 and conducted by Evaluator Becky Mann
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250220153742
FACILITY NAME:VALLEY CRESTFACILITY NUMBER:
365530263
ADMINISTRATOR:JORDAN, KIMBERLYFACILITY TYPE:
740
ADDRESS:18524 CORWIN RDTELEPHONE:
(760) 242-3188
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:65CENSUS: 36DATE:
04/01/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Gabriel Aguilar, AdministratorTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff do not ensure special dietary plans are followed for residents in care
Staff use medication restraint on residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA Mann met with Gabriel Aguilar, Administrator and explained the purpose of today's visit. The investigation consisted of LPA observations, pertinent document reviews, and interviews with staff and residents.

The allegation that staff do not ensure special dietary plans are followed for residents in care. LPA toured the facility and observed in the kitchen that there was a special dietary menu for residents who are on a special dietary plan. Interviews with kitchen staff also stated that some residents are provided a special dietary meal plan. Based on LPA observations, interviews and record reviews, staff do follow the special dietary plans for residents. The residents interviewed, there was not enough evidence to corroborate the allegation.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025
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-20250220153742
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: VALLEY CREST
FACILITY NUMBER: 365530263
VISIT DATE: 04/01/2025
NARRATIVE
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The allegation that staff use medication restraint on residents in care. All staff interviewed denied that they use medication restraint on residents in care. Some residents interviewed were not able to respond due to cognitive impairment.

Based on evidence obtained during the investigation, the above allegations are Unsubstantiated; meaning 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 was provided to Gabriel Aguilar, Administrator at the conclusion of the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2