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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366423704
Report Date: 06/09/2025
Date Signed: 06/09/2025 02:23:15 PM

Substantiated


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
05/20/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20250520085037
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: 6DATE:
06/09/2025
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:House Manager Denise ColvinTIME COMPLETED:
02:35 PM
ALLEGATION(S):
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License did not adhere to eviction protocs with residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to deliver findings on the allegation mentioned. LPA met with House Manager Denise Colvin and explained the purpose of the visit. The Department's investigation involved observations, interviews, and records review.

The allegation indicates Administrator/Licensee did not adhere to eviction protocols with residents in care. During the investigation, LPA Ramirez was able to obtain evidence to corroborate the allegation above. LPA conducted six (6) resident interviews, four (4) residents indicated that the Administrator did provide sixty (60) days written notice of eviction due to the facility renovations. Four (4) staff interviewed informed LPA residents were given (60) day evictions notices.

Records review indicated that the Administrator provided Eviction Notice to residents on April 28, 2025 and residents were requested to vacate the facility by June 28,2025.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
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 3
Control Number 56-AS-20250520085037
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: AASPEN VILLAGECARE II
FACILITY NUMBER: 366423704
VISIT DATE: 06/09/2025
NARRATIVE
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Based on LPA Ramirez interviews, observation, and records review, the preponderance of evidence standard has been met, and therefore the above allegation of eviction protocols were not met is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulations, (Title 22, Division 6 & Chapter 8) is being cited on the attached LIC9099D.

An exit interview was conducted where this report, LIC9099, LIC9099D, and Appeal Rights were discussed and provided to house Manager Denise Colvin.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20250520085037
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: AASPEN VILLAGECARE II
FACILITY NUMBER: 366423704
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2025
Section Cited
HSC
1569.682
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1569.682 Transfer of resident upon forfeiture of license or change in use of facility; duties of licensee; closure plan; duty of department upon licensee’s failure to comply; civil penalties(a) A licensee of a licensed residential care facility for the elderly shall, prior to transferring a resident of the facility to another facility or to an independent living arrangement as a result of the forfeiture of a license...or a change of use of the facility pursuant to the department’s regulations, take all reasonable steps to transfer affected residents safely and to minimize possible transfer trauma……..(b) If seven or more residents of a residential care facility for the elderly will be transferred...the licensee shall submit a proposed closure plan to the department for approval. The department shall approve or disapprove the closure plan, and monitor its implementation...(6) Until the department has approved a licensee’s closure plan, the facility shall not issue a notice of transfer or require any resident to transfer.
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Administrator was advised to discuss with Licensee to submit closer plan and updated eviction notices to be approved by CCLD. Administrator was advised once the closure plan is submitted and approved, eviction dates are reset.
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This requirement was not met as evidenced by: Based upon record review and interviews, Administrator/Licensee did not submit closure plan to CCLD for approval. This violation posed a potential health and safety risk to residents in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3