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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366423704
Report Date: 07/07/2025
Date Signed: 07/07/2025 11:54:12 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
07/02/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20250702113737
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: 0DATE:
07/07/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Administrator Chris Tanabe TIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Staff does not ensure residents are provided a comfortable temperature.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Chris Tanabe, and discussed the purpose of the visit.

LPA was unable to conduct a walkthrough of facility due to being closed for renovations and no residents in care. LPA conducted two (2) staff interviews, staff informed LPA the facility temperature was kept between 72-74 Degrees F. LPA conducted one (1) resident interview informing LPA the facility temperature was not always hot, the facility kept a machine that blew out cold air throughout the facility. Based on LPA’s previous visit, the facility temperature was kept at a comfortable temperature.

Based on observation, interviews, and pertinent documents the allegation is unsubstantiated. An Unsubstantiated complaint means, 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 with Administrator Chris Tanabe and a copy of this report was provided at the conclusion of the visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
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
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
07/02/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20250702113737

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: 0DATE:
07/07/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Administrator Chris TanabeTIME COMPLETED:
12:05 PM
ALLEGATION(S):
1
2
3
4
5
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8
9
Staff does not ensure facility is free of bed bugs.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Chris Tanabe, and discussed the purpose of the visit.

LPA was unable to conduct a walkthrough of facility due to being closed for renovations and no residents in care. LPA has received confirmation from staff that the facility has bud bugs, an exterminator conducted a spray for bedroom #1 on 6/28/25 and are in communication with the exterminator to return to the facility for a thorough spray of the entire facility.

Based on interviews, observation, and records review, the preponderance of evidence standard has been met, and therefore the above allegation 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 the Licensing reports were discussed and copies of the reports with Appeal Rights were provided to Administrator Chris Tanabe at the conclusion of the visit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20250702113737
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: 07/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2025
Section Cited
CCR
80087(a)
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87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Administrator contacted exterminator to notify all residents have been removed from the facility and will schedule a day to return and spray the entire facility. An invoice will be provided to LPA when visit is conducted.
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Based on observation and interviews, the administrator/Licensee did not comply with the section cited above by not ensuring facility is free of pests. This violation poses a potential health and safety risk to residents/staff 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: 07/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3