<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366427615
Report Date: 10/07/2024
Date Signed: 05/22/2025 12:22:52 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/04/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241004125615
FACILITY NAME:GARDEN VILLE HOME CAREFACILITY NUMBER:
366427615
ADMINISTRATOR:ADA REYESFACILITY TYPE:
740
ADDRESS:6206 WALNUT AVETELEPHONE:
(909) 548-0487
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:6CENSUS: 6DATE:
10/07/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Dulce Redford, LicenseeTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not provide adequate food service.
Staff does not ensure facility has adequate food supply.
Staff does not ensure medication cabinet is locked.
Staff does not ensure facility is clean and sanitized.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to conduct a complaint investigation regarding the aforementioned allegations. LPA Prieto met with Licensee Dulce Redford and explained the elements of the complaint.

Allegation #1: LPA Prieto interviewed residents R1, R2, R3, R4, R5, and R6. All residents stated that they are provided adequate food service. LPA observed food being served to residents of good quantity and quality.

Allegation #2: During today's visit LPA observed a sufficient amount of perishables and non-perishables food supply at the facility.

Allegation #3: During today's visit staff were iinterviewed and deny leaving medication cabinet unlocked. LPA observed medication cabinet to be locked and inaccessible to clients under care.

Allegation #4: LPA Prieto toured the facility and found it to be clean and sanitized. Residents' bathrooms were observed to be clean and free from odors. Hallways were clear of any obstructions, and the facility's vent covers were clean and functioning properly.

Based on the information obtained, there is insufficient evidence to support the allegations made in this complaint. Therefore, these allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Licensee Redford, and a copy was left with the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
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 1