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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366423704
Report Date: 05/19/2025
Date Signed: 05/19/2025 12:46:45 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
05/12/2025 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250512153450
FACILITY NAME:AASPEN VILLAGECARE IIFACILITY NUMBER:
366423704
ADMINISTRATOR:MUSHTAQ KHANFACILITY TYPE:
740
ADDRESS:7645 KICKAPOO TRAILTELEPHONE:
(760) 365-6338
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:15CENSUS: 10DATE:
05/19/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Denise Colvin and Chris TanabeTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff did not ensure that facility has an adequate amount of food in refrigerator and freezer for the residents
Staff did not ensure that there is substance or variety in the food served to the residents
Staff did not ensure that food served to the residents matches what is on the menu
Staff is not following the residents' special diets
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met House Manager, Denise Colvin and Administrator, Chris Tanabe and informed the purpose of the visit.

Regarding the allegation, staff did not ensure that facility has an adequate amount of food in refrigerator and freezer for the residents, LPA observed an adequate amount of food in facility refrigerators and freezers. Administrator and staff interviews reveal they do ensure that facility has an adequate amount of food in refrigerator and freezer. Five (5) residents interviews reveal they are provided sufficient amount of food during meal service.

Regarding the allegation, staff did not ensure that there is substance or variety in the food served to the residents, LPA observed a variety of perishable and non-perishable food stored at the facility. Administrator and staff interviews reveal they do ensure that there is substance or variety in the food served to the residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
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-20250512153450
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: AASPEN VILLAGECARE II
FACILITY NUMBER: 366423704
VISIT DATE: 05/19/2025
NARRATIVE
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Four (4) out of five (5) resident interviews reveal that there is substance and/or variety in the food served to them.

Regarding the allegation, staff did not ensure that food served to the residents matches what is on the menu, interviews with the Administrator and staff reveals the facility prepares a sample menu. Menus are changed and food is bought according to resident's request and special events. Three (3) out of (5) residents interviews reveal that they do not request to see a menu but staff do ask for suggestions of meals they will like to be served.

Regarding the allegation, staff is not following the residents' special diets, interviews with the Administrator and staff deny not following the residents' special diets. Interviews with five (5) residents reveal not enough evidence to corroborate the allegation.

Based on the investigation findings, the allegations are Unsubstantiated. An 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 and a copy of this report with appeal rights was provided to Administrator Tanabe at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2