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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366405771
Report Date: 02/03/2025
Date Signed: 02/03/2025 02:29:47 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
01/27/2025 and conducted by Evaluator Sarina Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250127145545
FACILITY NAME:REST HAVEN CARE HOMEFACILITY NUMBER:
366405771
ADMINISTRATOR:REEDER, NELFAFACILITY TYPE:
740
ADDRESS:11530 ORANGE GROVETELEPHONE:
(909) 328-2569
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:6CENSUS: 4DATE:
02/03/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Nelfa ReederTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are chemically restraining residents in care.
Neglect resulting in UTI.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Nelfa Reeder, and discussed the purpose of the visit.

During today’s visit, LPA conducted observations, interviewed staff, residents, outside parties and obtained facility records.

It is alleged that staff are chemically restraining residents in care. R1 no longer resides at the facility and was unable to be interviewed. LPA conducted 2 resident interviews, 1 out of 2 residents stated they do not take any medication. 1 out of 2 residents informed LPA they are not being over medication nor have they seen other residents being over medicated.

LPA interviewed 2 staff members. 2 out of 2 staff informed LPA residents are not being chemically
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025
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-20250127145545
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: REST HAVEN CARE HOME
FACILITY NUMBER: 366405771
VISIT DATE: 02/03/2025
NARRATIVE
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restrained.

Based on LPA's observation and medication review, residents are receiving medication as prescribed by physician and are not being chemically restrained.

Regarding allegation #2, based on observation, record review, and interviews LPA Ramirez was unable to corroborate the allegation of Resident(s) developed UTI due to neglect. No current residents have UTI(s) that resulted from neglect.


Based on the information above, the allegation is unsubstantiated. A finding of 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. An exit interview was conducted where this report LIC 9099 and LIC9099C was discussed, and a copy was provided to Administrator Nelfa Reeder.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2