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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800160
Report Date: 09/25/2024
Date Signed: 09/25/2024 11:57:40 AM

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
09/23/2024 and conducted by Evaluator Janette Romero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240923085515
FACILITY NAME:HIGHGATE SENIOR LIVING-TEMECULAFACILITY NUMBER:
331800160
ADMINISTRATOR:WILLIAMS, KATHLEENFACILITY TYPE:
740
ADDRESS:42301 MORAGA ROADTELEPHONE:
(951) 308-1885
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY:99CENSUS: 97DATE:
09/25/2024
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Administrator, Ricardo GomezTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff does not ensure bedroom door for resident is in good repair
INVESTIGATION FINDINGS:
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On 9/25/2024, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to investigate the allegation listed above. LPA met with Administrator, Ricardo Gomez, Maintenance Manager, Daryl Wilkes, and Health Director (HD), Susanne Larson who were all informed of the purpose of the visit.

It was alleged Resident 1's (R1's) bedroom door knob is in disrepair as keys are unable to unlock R1's door from the outside. During today's visit, LPA toured the facility, conducted interviews, and obtained copies of pertinent records. LPA was informed residents have a key to unlock their room from the outside and authorized personnel, such as caregivers, have master keys to open resident rooms from the outside as well. LPA toured R1's room and observed R1's bedroom door knob has a turn button on the inside and requires a keyed entry from the outside. LPA observed R1 physically use their key to unlock their bedroom door from the outside without any issues. R1 was interviewed and reported they have not experienced any issues using their key to unlock their bedroom door from the outside and are not aware of any staff having issues unlocking/opening their door. LPA observed R1 physically lock and unlock their bedroom door from both the inside and outside without issue. LPA also observed facility staff physically use two (2) separate keys to unlock R1's door without issue.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
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 2
Control Number 18-AS-20240923085515
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: HIGHGATE SENIOR LIVING-TEMECULA
FACILITY NUMBER: 331800160
VISIT DATE: 09/25/2024
NARRATIVE
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 Five (5) staff were interviewed and all reported being able to use a master key to unlock R1's bedroom door from the outside. Five (5) staff interviewed reported not having knowledge of any resident doorknobs in disrepair. Additionally, LPA reviewed the facility's Maintenance Requests for September 2024 and did not observe a request to repair/replace R1's bedroom door knob. Based on the aforementioned, this agency has investigated the complaint alleging "Staff does not ensure bedroom door for resident is in good repair". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator Gomez and HD Larson.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2