Inspection Reports for Rose Valley Redlands Residential Care Facility For The Elderly
153 S Dearborn St, Redlands, CA 92374, CA, 92374
Back to Facility ProfileInspection Report Summary
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.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
2.4 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
40% better than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
100% occupied
Based on a July 2025 inspection.
Census over time
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Date: Jul 14, 2025
Visit Reason
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.
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.
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.
Report Facts
Capacity: 6
Census: 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 |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Date: Nov 25, 2024
Visit Reason
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.
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.
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.
Report Facts
Staff interviewed: 3
Residents interviewed: 5
Facility capacity: 6
Facility census: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sarina Ramirez | Licensing Program Analyst | Conducted the complaint investigation |
| Becky Mann | Licensing Program Analyst | Conducted the complaint investigation |
| Karen Clemons | Licensing Program Manager | Oversaw the complaint investigation |
| Mistie Felton | House Manager | Facility representative met during investigation |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Date: Nov 25, 2024
Visit Reason
An unannounced complaint investigation was conducted based on multiple allegations received regarding staff conduct and care practices at the facility.
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.
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.
Report Facts
Capacity: 6
Census: 6
Staff interviews: 3
Resident interviews: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sarina Ramirez | Licensing Program Analyst | Conducted the complaint investigation |
| Becky Mann | Licensing Program Analyst | Conducted the complaint investigation |
| Karen Clemons | Licensing Program Manager | Oversaw the complaint investigation |
| Mistie Felton | House Manager | Facility representative met during investigation |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Date: Nov 25, 2024
Visit Reason
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.
Complaint Details
The complaint investigation was unsubstantiated, meaning there was not sufficient evidence to prove the alleged violations occurred.
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.
Report Facts
Staff interviews conducted: 3
Resident interviews conducted: 5
Facility capacity: 6
Facility census: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Sarina Ramirez | Licensing Program Analyst | Conducted complaint investigation |
| Becky Mann | Licensing Program Analyst | Conducted complaint investigation |
| Mistie Felton | House Manager | Met with investigators during complaint investigation |
| Karen Clemons | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 1
Date: Nov 25, 2024
Visit Reason
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.
Deficiencies (1)
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.
Report Facts
Resident files reviewed: 6
Staff files reviewed: 5
Plan 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 |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 1
Date: Oct 7, 2024
Visit Reason
The visit was a case management inspection initiated based on deficiencies observed during a complaint investigation #56-AS-20241004092109.
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.
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.
Deficiencies (1)
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.
Report Facts
Capacity: 6
Census: 5
Plan 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 |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 1
Date: Jun 12, 2024
Visit Reason
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.
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.
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.
Deficiencies (1)
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.
Report Facts
Civil penalty amount: 100
Deficiency count: 1
Plan of Correction due date: Jun 13, 2024
Plan 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 |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 2
Date: Jan 4, 2024
Visit Reason
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.
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.
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.
Deficiencies (2)
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: 6
Census: 6
Plan 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 |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 5
Date: Nov 6, 2023
Visit Reason
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)
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: 6
Census: 6
Resident files reviewed: 3
Staff files reviewed: 3
Hot water temperature: 112
Plan 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 |
| Glenn Bernal | Administrator | Facility administrator named in report header |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 1
Date: Nov 23, 2022
Visit Reason
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.
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.
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.
Deficiencies (1)
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.
Report Facts
Capacity: 6
Census: 6
Deficiencies 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 |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 1
Date: Nov 23, 2022
Visit Reason
An unannounced complaint investigation was conducted based on allegations received on 10/06/2020 regarding staff mismanaging medication and lack of proper staff training.
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.
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.
Deficiencies (1)
Lack of record or proof of completion of medication training for staff members.
Report Facts
Resident Medication Administration Records reviewed: 6
Residents with missing medication signatures: 4
Facility capacity: 6
Facility 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 |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Date: Aug 16, 2022
Visit Reason
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: 3
PPE supply duration: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Iren Creighton | Caregiver | Met during inspection and involved in infection control discussion |
| Ryan Gardner | Licensing Program Analyst | Conducted the inspection visit |
| Karen Clemons | Licensing Program Manager | Named in report header and narrative |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Date: Oct 18, 2021
Visit Reason
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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