331800073-9-18-2025-18-AS-APEZ-DLZVWK-20250930164805

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800073
Report Date: 09/18/2025
Date Signed: 09/18/2025 03:47:17 PM

Unfounded

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
01/17/2024 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240117100409

FACILITY NAME:	VINEYARD PLACE		FACILITY NUMBER:	331800073
ADMINISTRATOR:	ARLENE CRAWFORD		FACILITY TYPE:	740
ADDRESS:	24325 WASHINGTON AVE		TELEPHONE:	(951) 387-8410
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY:	82	CENSUS: 56	DATE:	09/18/2025
		UNANNOUNCED	TIME BEGAN:	03:07 PM
MET WITH:	Angela Jackson, Community Relations director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff neglect resulted in a resident sustaining a pressure injury.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, the LPA met with Angela Jackson, Community Relations Director and explained the reason of the visit.

On 01/17/2024, the Riverside Adult and Senior Care Regional Office (RO) received a complaint report regarding neglect resulted in a resident sustaining a pressure injury. It was alleged that on 10/12/2023, Resident #1 (R1) was bedridden and observed to have maggots on R1’s pressure injury.

The Department’s investigation revealed on 05/06/2023, R1 was admitted back to the facility from the hospital with a Stage II pressure injury to coccyx and was placed on hospice due to R1’s inability to thrive. R1 began receiving wound care treatments and additional services under a hospice agency. Facility staff were directed to reposition R1 every 2 hours and provide incontinent care every 2 hours or more

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

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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Control Number 18-AS-20240117100409

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: 09/18/2025

NARRATIVE

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frequently if needed. The police department was contacted to request records; however, no reports were found involving R1 or the facility. There were no documents or photos submitted with the complaint and the Department was unable to obtain any additional information regarding the allegation.

The information obtained during the course of the investigation from the hospice agency revealed the hospice and wound care nurses denied the allegation to be true. They indicated that there was no indication of maggots on R1’s pressure injury or body. Additionally, the wound care and progress notes were obtained. The progress notes, specifically on the date of the allegation, 10/12/2023, annotated that wound care services were rendered, and no unusual skin changes were noted. The facility staff denied the allegation of neglect/lack of care and never observed any maggots on R1’s body. Based on the Department’s investigation, the allegation is deemed Unfounded at this time. A finding of Unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted, where a copy of this report, LIC811-Confidential names list, was reviewed and provided to Angela Jackson, Community Relations Director.

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

LIC9099 (FAS) - (06/04)

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