Most inspections found no deficiencies, and several complaint investigations were unsubstantiated, including recent ones on July 14, 2025, and November 25, 2024. The facility has generally maintained compliance with care, safety, and infection control standards, with no fines or enforcement actions listed in the available reports. Some deficiencies were noted in earlier reports, primarily related to documentation issues such as incomplete staff clearances, missing resident records, and admitting a resident with dementia without proper licensing or care plans. There was also a substantiated pest control issue in mid-2024 that led to ongoing civil penalties until resolved. The most recent report from July 14, 2025, showed no deficiencies, indicating improvement over time.
An unannounced complaint investigation visit was conducted in response to allegations received on 2024-04-11 regarding staff behavior and resident care at Rose Valley Redlands facility.
Findings
The investigation found no evidence to corroborate the allegations that staff yelled at residents, denied residents water, or failed to provide toileting assistance. The complaint was determined to be unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated based on interviews with residents and staff, file reviews, and facility observations. Allegations included staff yelling at residents, denying water, and not providing toileting assistance, none of which were corroborated.
Report Facts
Capacity: 6Census: 6
Employees Mentioned
Name
Title
Context
Eldin Serrano
Licensing Program Analyst
Conducted the complaint investigation and authored the report
Karen Clemons
Licensing Program Manager
Oversaw the complaint investigation
Mistie Felton
House Manager
Facility representative met during the investigation
An unannounced complaint investigation was conducted in response to multiple allegations received on 2024-11-20 regarding staff misconduct and resident care issues at Rose Valley Redlands facility.
Findings
The investigation found all allegations unsubstantiated based on staff and resident interviews, observations, and record reviews, indicating no evidence to prove the alleged violations occurred.
Complaint Details
The complaint investigation was triggered by allegations including staff consuming liquor on shift, lack of fingerprint clearance, locking facility doors to prevent residents from leaving, staff inserting suppositories, incomplete trainings, falsified records, improper food service, and unmet diapering needs. All allegations were found unsubstantiated.
An unannounced complaint investigation was conducted based on multiple allegations received regarding staff conduct and care practices at the facility.
Findings
The investigation found all allegations to be unsubstantiated based on staff and resident interviews, observations, and record reviews, indicating no evidence of the alleged violations.
Complaint Details
The complaint included nine allegations related to staff not informing physicians of changes, inadequate medication assistance, refusal to call ambulance, threatening residents, insufficient food, inappropriate resident interactions, yelling at residents, failure to assist after falls, and medication accessibility. All were found unsubstantiated.
An unannounced complaint investigation was conducted based on allegations received on 2024-11-20 regarding fire evacuation plan, infection control plan, reporting requirements, and staff leaving residents unattended.
Findings
The investigation found that staff have a fire evacuation plan and infection control plan, follow reporting requirements, and do not leave residents unattended. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was unsubstantiated, meaning there was not sufficient evidence to prove the alleged violations occurred.
Licensing Program Analysts conducted an unannounced required annual inspection of the Residential Care Facility for the Elderly to assess compliance with licensing regulations.
Findings
The facility was found to be generally compliant with physical plant, food service, care and supervision, and medical related services standards. However, a deficiency was cited for failure to associate a staff member (S#1) with the facility through a required criminal record clearance transfer, posing an immediate health and safety risk.
Severity Breakdown
Type A: 1
Deficiencies (1)
Description
Severity
Licensee did not comply with criminal record clearance requirements by not associating staff member S#1 to the facility through guardian, posing an immediate health, safety or personal rights risk to persons in care.
Type A
Report Facts
Resident files reviewed: 6Staff files reviewed: 5Plan of Correction Due Date: Nov 26, 2024
Employees Mentioned
Name
Title
Context
Mistie Felton
House Manager
Met with Licensing Program Analysts during inspection and discussed findings
Sarina Ramirez
Licensing Program Analyst
Conducted inspection and authored report
Becky Mann
Licensing Program Analyst
Conducted inspection
Karen Clemons
Licensing Program Manager
Supervisor and Licensing Program Manager overseeing inspection
The visit was a case management inspection initiated based on deficiencies observed during a complaint investigation #56-AS-20241004092109.
Findings
The facility failed to maintain resident records for two former residents for the required minimum of three years following termination of service, posing a potential health, safety, or personal rights risk.
Complaint Details
The inspection was triggered by complaint investigation #56-AS-20241004092109. The deficiency was substantiated as the facility did not maintain required resident records.
Severity Breakdown
Type B: 1
Deficiencies (1)
Description
Severity
Failure to maintain records for resident #1 and resident #2 for three years following termination of service as required by Title 22, division 6, California Code of Regulations.
Type B
Report Facts
Capacity: 6Census: 5Plan of Correction Due Date: Oct 14, 2024
Employees Mentioned
Name
Title
Context
Magda Malcore
Licensing Program Analyst
Initiated case management visit and cited deficiency
Renese Howell-Small
Licensing Program Analyst
Initiated case management visit
Mistie Felton
House Manager
Met with LPAs during inspection and provided information about resident records
Karen Clemons
Licensing Program Manager
Supervisor and Licensing Program Manager overseeing the inspection
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations including staff mismanaging resident's medication, inappropriate behaviors by staff in the presence of residents, failure to keep resident's personal information confidential, and presence of pests in the facility.
Findings
The allegations regarding medication mismanagement, inappropriate staff behaviors, and confidentiality breaches were found to be unsubstantiated based on interviews and observations. However, the allegation of pest presence was substantiated, with evidence of mice droppings and lack of outside pest control services, resulting in a cited deficiency and ongoing civil penalties until corrected.
Complaint Details
The complaint investigation was triggered by allegations received on 12/27/2023. The allegations included staff mismanaging medications, inappropriate behaviors in presence of residents, failure to keep resident information confidential, and presence of pests. The first three allegations were unsubstantiated, while the pest allegation was substantiated. Civil penalties of $100 per day will accrue until correction is verified.
Severity Breakdown
Type A: 1
Deficiencies (1)
Description
Severity
The licensee did not comply with the requirement to obtain outside pest control services to ensure the facility was free of mice, posing a potential health, safety, or personal rights risk to persons in care.
Type A
Report Facts
Civil penalty amount: 100Deficiency count: 1Plan of Correction due date: Jun 13, 2024Plan of Correction completion date: Jun 18, 2024
Employees Mentioned
Name
Title
Context
Magda Malcore
Licensing Program Analyst
Conducted the complaint investigation and authored the report
Mistie Felton
House Manager
Met with Licensing Program Analyst during the investigation and discussed findings
Karen Clemons
Licensing Program Manager
Named as Licensing Program Manager overseeing the investigation
The inspection was an unannounced complaint investigation visit triggered by a complaint alleging that staff were not properly cleaning the floors and that the facility was in disrepair.
Findings
The allegation regarding improper floor cleaning was found to be unsubstantiated based on observations and interviews. However, the allegation that the facility was in disrepair was substantiated, with findings including missing and loose tile pieces around the kitchen sink exposing rock and gravel, a broken glass window in a resident's bedroom, and a heater that was not functioning properly.
Complaint Details
The complaint investigation was unannounced and conducted by Licensing Program Analyst Magda Malcore. The complaint was partially substantiated: the floor cleaning allegation was unsubstantiated, but the facility disrepair allegation was substantiated. The report includes details of interviews with staff and residents, observations of the facility, and discussions with the licensee regarding heater and garage door repairs.
Deficiencies (2)
Description
Missing tile pieces and loose tile pieces around the kitchen sink exposing rock and gravel.
Broken glass window in resident #1's bedroom posing a potential health, safety, or personal rights risk.
Report Facts
Capacity: 6Census: 6Plan of Correction Due Date: Jan 26, 2024
Employees Mentioned
Name
Title
Context
Magda Malcore
Licensing Program Analyst
Conducted the complaint investigation and authored the report
Glenn Bernal
Administrator
Facility administrator named in the report
Mistie Felton
House Manager
Met with the Licensing Program Analyst during the investigation
Nick Vermani
Licensee who provided information about heater and garage door repairs
Karen Clemons
Licensing Program Manager
Named as Licensing Program Manager overseeing the investigation
Licensing Program Analyst Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection of the Residential Care Facility for the Elderly (RCFE).
Findings
The inspection found the facility generally maintained safe and sanitary conditions, adequate food supply, and 24/7 care staff with criminal clearances. However, deficiencies were cited related to incomplete health screening verification for staff and residents, incomplete preplacement appraisals, lack of proof of liability insurance, and failure to conduct recent emergency drills.
Deficiencies (5)
Description
Licensee did not maintain verification of staff #1 complete health screening results.
Licensee did not maintain verification of liability insurance on file for licensing review.
Resident #1 and resident #2 preplacement appraisals were observed incomplete.
Resident #1 did not have verification of complete health screening results.
Last emergency drill was conducted in July 2019, not meeting quarterly drill requirements.
Report Facts
Capacity: 6Census: 6Resident files reviewed: 3Staff files reviewed: 3Hot water temperature: 112Plan of Correction Due Date: Nov 27, 2023
Employees Mentioned
Name
Title
Context
Magda Malcore
Licensing Program Analyst
Conducted the inspection and cited deficiencies
Karen Clemons
Licensing Program Manager
Supervisor of the inspection
Iren Creighton
Facility Representative
Met with Licensing Program Analyst during inspection and discussed findings
The visit was an unannounced complaint investigation related to complaint number 18-AS-20201006151422 to investigate and deliver findings regarding the facility's admission of a resident with a Dementia diagnosis.
Findings
The investigation found that one of six residents had a Dementia diagnosis, but the facility is not licensed to admit Dementia residents and does not have a dementia care plan, posing an immediate health and safety risk.
Complaint Details
Complaint number 18-AS-20201006151422 was investigated and substantiated with findings of noncompliance related to admitting a resident with Dementia without proper licensing or care plan.
Severity Breakdown
Type A: 1
Deficiencies (1)
Description
Severity
Plan of Operation - A licensee who accepts or retains residents diagnosed by a physician to have dementia shall include additional information in the plan of operation as specified in Section 87705(b). This requirement was not met as evidenced by Resident 1 having a primary diagnosis of Dementia.
Type A
Report Facts
Capacity: 6Census: 6Deficiencies cited: 1
Employees Mentioned
Name
Title
Context
Iren Creighton
Assistant Administrator
Met during inspection and discussed exit interview
Anna Bueno
Licensing Program Analyst
Conducted the complaint investigation and authored the report
Amber Coleman
Licensing Program Analyst
Conducted the complaint investigation
Nedra Brown
Licensing Program Manager
Supervisor and Licensing Program Manager overseeing the investigation
An unannounced complaint investigation was conducted based on allegations received on 10/06/2020 regarding staff mismanaging medication and lack of proper staff training.
Findings
The investigation substantiated that medication administration records for 4 of 6 residents were missing signatures, indicating mismanagement of medication. Additionally, there was no evidence that staff completed required medication training. Other allegations related to rough handling of residents, hygiene, administrator presence, and feeding were found unsubstantiated.
Complaint Details
The complaint investigation was substantiated for medication mismanagement and lack of staff training. Other allegations including rough handling of residents, unmet hygiene needs, administrator absence, and inadequate feeding were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
Description
Severity
Lack of record or proof of completion of medication training for staff members.
Type B
Report Facts
Resident Medication Administration Records reviewed: 6Residents with missing medication signatures: 4Facility capacity: 6Facility census: 6
Employees Mentioned
Name
Title
Context
Amber Coleman
Licensing Program Analyst
Conducted complaint investigation
Anna Bueno
Licensing Program Analyst
Assisted in complaint investigation
Patrick C Lee
Administrator
Facility administrator involved in plan of correction
Delfina Villamore
Staff member who greeted investigators and was interviewed
The visit was conducted as a required annual inspection with an emphasis on infection control due to the COVID-19 pandemic.
Findings
No deficiencies were cited during the inspection. The facility has a COVID-19 infection control plan in place, including visitor screening, PPE supply management, and staff training, but was notified to obtain a full 30-day supply of PPE items.
Report Facts
Staff present: 3PPE supply duration: 30
Employees Mentioned
Name
Title
Context
Iren Creighton
Caregiver
Met during inspection and involved in infection control discussion
Licensing Program Analyst Javier Prieto made an unannounced visit to conduct an annual inspection with an emphasis on infection control.
Findings
No deficiencies were cited during the inspection. The facility demonstrated proper infection control measures including signage, hand hygiene supplies, PPE use, and staff training.
Employees Mentioned
Name
Title
Context
Javier Prieto
Licensing Program Analyst
Conducted the annual inspection and made observations on infection control.
Glenn Bernal
Administrator
Facility administrator mentioned in the report header.
Ella Agdaca
Met with the Licensing Program Analyst during the inspection.
Karen Clemons
Licensing Program Manager
Named as Licensing Program Manager in the report.
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