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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366423788
Report Date: 05/09/2025
Date Signed: 05/09/2025 11:40:42 AM

Unfounded


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
06/27/2023 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230627113631
FACILITY NAME:AASPEN VILLAGECAREFACILITY NUMBER:
366423788
ADMINISTRATOR:MUSHTAQ KHANFACILITY TYPE:
740
ADDRESS:7633 KICKAPOO TRAILTELEPHONE:
(909) 263-7547
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:15CENSUS: 13DATE:
05/09/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Amanda RobertsTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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9
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:
1
2
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint investigation on the above allegations. LPA met with House Manager, Amanda Roberts, to discuss the purpose of the visit.

Regarding the allegations, 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, the investigation reveals the complaint was filed under a similar name but incorrect facility number.

Based on investigation findings, the allegations above are Unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.
An exit interview was conducted where this report was reviewed and a copy provided to the House Manager at the conclusion of the visit.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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