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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800073
Report Date: 01/09/2026
Date Signed: 01/09/2026 11:40:24 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE 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
07/18/2022 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220718093804
FACILITY NAME:VINEYARD PLACEFACILITY NUMBER:
331800073
ADMINISTRATOR:ARLENE CRAWFORDFACILITY TYPE:
740
ADDRESS:24325 WASHINGTON AVETELEPHONE:
(951) 387-8410
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:82CENSUS: 63DATE:
01/09/2026
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Angela Jackson, Community Relations DirectorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff not abiding by resident's care plan
Staff restricting visitation to residents
Staff over-medicating resident
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Seo Jeon and Kyle Wellington conducted an unannounced visit to the facility to deliver findings of the above allegations. LPA met Angela Jackson, Community Relations Director. The Department investigation involved interviews with staff and residents and review of records.

On July 18, 2022, Community Care Licensing (The Department) received a complaint report with the following allegations.

It was alleged that staff are not following resident’s care plan. Specifically, the concern was that Resident #1 (R1) was not receiving care in accordance with their care plan. LPA’s file review revealed that R1 was non-ambulatory who required a Hoyer lift for transferring. LPA conducted an interview with R1 who stated that they had received all the care and assistance from the facility staff.

Continued on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
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 6
Control Number 18-AS-20220718093804
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VINEYARD PLACE
FACILITY NUMBER: 331800073
VISIT DATE: 01/09/2026
NARRATIVE
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LPA conducted interviews with two (2) residents who had relevant parties visiting at the time. Both residents and their relevant parties confirmed that staff were providing care consistent with their individual care plans. LPA conducted interview with eight (8) staff members, all of whom stated that care plans are being followed for all residents. LPA’s attempted interviews with six (6) previous staff members who had worked at the facility in year 2022 were unsuccessful. The Department’s investigation did not provide enough information to corroborate the allegation that staff are not following resident’s care plan. Based on the file review and interviews conducted, this allegation is unsubstantiated.

It was alleged staff are restricting visitation to residents. The information received indicated that visiting hours were enforced and that only two visitors were allowed at a time. During an interview, LPA spoke with the Administrator, who stated that staff have never denied visitation to any individuals, as long as visitors completed the required symptom screening questionnaire. This statement was corroborated by eight (8) staff members interviewed by the LPA, all of whom confirmed that visitation has not been restricted. LPA’s interview with R1 confirmed R1 had visitors without any issues. Additionally, two other residents and their responsible parties were interviewed, and all affirmed that no one had ever been denied visitation. The Administrator further confirmed that no visitors had ever been denied access to R1. LPA’s attempted interviews with six (6) previous staff members who had worked in year 2022 were unsuccessful. The Department’s investigation did not provide enough information to corroborate the allegation that staff are restricting visitation to residents. Based on interviews conducted, this allegation is unsubstantiated.

It was alleged staff are over-medicating resident. According to information received, R1 appeared to be “groggy” each time visits were conducted. A review of records by LPA revealed that R1 was admitted to the facility in December 2021, began receiving hospice care in June 2022, and passed away in August 2022. LPA reviewed R1’s medication administration records but did not find any information to support the allegation. Interviews conducted with a Licensed Vocational Nurse (LVN) and a medication technician confirmed that all medications are dispensed strictly according to physicians’ prescriptions. Neither staff member was aware of any incidents involving over-medication. Additionally, the LPA interviewed eight (8) staff members, all of whom denied witnessing any residents who appeared over-medicated. LPA’s attempted interviews with six (6) previous staff members who had worked in year 2022 were unsuccessful. The Department’s investigation did not provide enough information to corroborate the allegation that staff are over-medicating resident. Based on interviews conducted and records review, this allegation is unsubstantiated. Continued on LIC9099-C....

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 18-AS-20220718093804
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VINEYARD PLACE
FACILITY NUMBER: 331800073
VISIT DATE: 01/09/2026
NARRATIVE
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A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted where a copy of this report was provided.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE 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
07/18/2022 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220718093804

FACILITY NAME:VINEYARD PLACEFACILITY NUMBER:
331800073
ADMINISTRATOR:ARLENE CRAWFORDFACILITY TYPE:
740
ADDRESS:24325 WASHINGTON AVETELEPHONE:
(951) 387-8410
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:82CENSUS: 63DATE:
01/09/2026
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Angela Jackson, Community Relations DirectorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Licensee not reporting incident
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Seo Jeon and Kyle Wellington conducted an unannounced visit to the facility to deliver findings of the above allegation. LPA met with Angela Jackson, Community Relations Director. The Department investigation involved interviews with staff and residents and review of records.

On July 18, 2022, Community Care Licensing (The Department) received a complaint report with the following allegations.

It was also alleged licensee is not reporting incident. According to information received, R1 fell out of bed in June 2022, but staff did not report the incident. LPA conducted an interview with the Administrator who stated they were not aware of any fall incidents with R1 in June 2022.

Continued on LIC9099-C....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 18-AS-20220718093804
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VINEYARD PLACE
FACILITY NUMBER: 331800073
VISIT DATE: 01/09/2026
NARRATIVE
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LPA’s records review revealed that R1 was admitted to the hospital on June 17, 2022, due to fever and shivering, and was discharged on June 26, 2022. However, the LPA’s review of facility records revealed that the Department did not receive any incident report related to R1’s hospitalization in June 2022. The Department’s investigation provided enough information to corroborate the allegation that licensee is not reporting incident. Based on records review and interviews conducted, this allegation is SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where a copy of this report was provided, along with a copy of LIC9099-D, and Appeal Rights were provided.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20220718093804
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VINEYARD PLACE
FACILITY NUMBER: 331800073
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/23/2026
Section Cited
CCR
87211
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87211 Reporting Requirements, (a) Each licensee shall furnish to the licensing agency..., (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision.
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Licensee will create comprehensive instruction for staff and in-service training with med/techs and nurses and send proof to CCLD by the due date.
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Based on records review, the Licensee did not report an incident to The Department. This posed a potential personal rights risk to the residents 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: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6