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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800114
Report Date: 07/20/2021
Date Signed: 07/20/2021 12:18:56 PM



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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/20/2020 and conducted by Evaluator Deborah Mullen
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200420102824
FACILITY NAME:VINEYARD RANCH AT TEMECULAFACILITY NUMBER:
331800114
ADMINISTRATOR:AREVALO, DONNAFACILITY TYPE:
740
ADDRESS:27350 NICOLAS RDTELEPHONE:
(530) 949-5018
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY:125CENSUS: 81DATE:
07/20/2021
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Kurt Knauer, Executive DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident is smoking inside of the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst's (LPAs) Deborah Mullen and Jesse Gardner conducted an unannounced visit to deliver the findings of the above allegation. LPAs met with Kurt Knauer, Executive Director. The department investigation included interviews with resident and staff.

Staff interviews revealed that on 4/19/2020 at approximately 7:30pm Resident 1 (R1) was confronting Resident 2 (R2) at the door of R2's apartment believing R2 was smoking marijuana in the apartment. Staff denied smelling smoke coming from R2's apartment or smelling smoke outside the apartment. R2 was interviewed and denied ever smoking in the apartment or smelling anyone else smoking in the building. R1 was unable to be interviewed as resident no longer resides in the building.

Based on the information obtained there is not enough evidence to corroborate the allegation that resident was smoking in the facility. The allegation is unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report, along with LIC 811 (Confidential Names List) was reviewed with and provided to Mr. Knauer.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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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