331800160-8-16-2024-18-AS-TDAN-DC62BX-20241220161548

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800160
Report Date: 08/16/2024
Date Signed: 08/16/2024 03:14:03 PM

Substantiated

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
08/12/2024 and conducted by Evaluator Janette Romero

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240812162904

FACILITY NAME:	HIGHGATE SENIOR LIVING-TEMECULA		FACILITY NUMBER:	331800160
ADMINISTRATOR:	WILLIAMS, KATHLEEN		FACILITY TYPE:	740
ADDRESS:	42301 MORAGA ROAD		TELEPHONE:	(951) 308-1885
CITY:	TEMECULA	STATE: CA	ZIP CODE:	92591
CAPACITY:	99	CENSUS: 97	DATE:	08/16/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Community Resources Manager, Lyssa Irani		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Licensee does not ensure the facility has an active Director on site

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

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 4

Control Number 18-AS-20240812162904

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: 08/16/2024

NARRATIVE

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DO Danielson was interviewed and reported they do not possess a DSS administrator's certificate and are not acting as the facility's current administrator. DO Danielson explained on 7/24/2024, the facility hired a new administrator, Ricardo Gomez, and the change of administrator request was submitted to DSS on 8/1/2024. DO Danielson reported their previous Administrator, Georgianna Mendez's last day with the facility was on 8/9/2024 and Administrator Gomez was scheduled to begin working in the facility on 8/10/2024; however, they have fallen ill and are expected to return to work on 8/19/2024. DO Danielson added the facility asked Administrator Mendez to provide coverage until Administrator Gomez was able to return to work but Administrator Mendez stated they were unable to stay and separated from the facility. DO Danielson added none of the facility's current employees possess a DSS administrator's certificate and no one is acting as the administrator during Administrator Gomez's absence.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099-D. An exit interview was conducted where a copy of this report was reviewed and provided to ALC Villafana along with the Appeal Rights.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 18-AS-20240812162904

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/16/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/30/2024 Section Cited CCR 87405(a)	1 2 3 4 5 6 7	87405(a) All facilities shall have a qualified and currently certified administrator. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated they will review regulation 87405 and submit a new Designation of Facility Responsibility (LIC308), designating a qualified administrator substitute. POC to be submitted to LPA by close of business on 8/30/2024.
	8 9 10 11 12 13 14	Based on interviews and records reviewed the facility does not have a designated substitute who has an administrator's certificate that can provide coverage during their current administrator's absence. This poses a potential health/safety/personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

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
08/12/2024 and conducted by Evaluator Janette Romero

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240812162904

FACILITY NAME:	HIGHGATE SENIOR LIVING-TEMECULA		FACILITY NUMBER:	331800160
ADMINISTRATOR:	WILLIAMS, KATHLEEN		FACILITY TYPE:	740
ADDRESS:	42301 MORAGA ROAD		TELEPHONE:	(951) 308-1885
CITY:	TEMECULA	STATE: CA	ZIP CODE:	92591
CAPACITY:	99	CENSUS: 97	DATE:	08/16/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Community Resources Manager, Lyssa Irani		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff do not ensure residents rooms are clean and orderly

INVESTIGATION FINDINGS:

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On 8/16/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to investigate the allegation listed above. LPA met with Community Resources Manager (CRM), Lyssa Irani and Assisted Living Coordinator (ALC), Melissa Villafana who were informed of the purpose of the visit.

It was alleged residents in both Assisted Living (AL) and Memory Care (MC) have pets that urinate and defecate in resident rooms, causing an intolerable odor in the resident rooms and facility hallways. It was also alleged one (1) resident in MC's pet defecates on their bed. LPA toured the facility, conducted interviews, and obtained copies of pertinent records. Three (3) residents in MC were identified to have pets in the facility. LPA interviewed all three (3) residents who reported their pets go to the facility's backyard to urinate and defecate and their pets have never urinated or defecated on their bed. A staff interview conducted revealed both staff and residents allow pets to go outside throughout the day and there are no reports of pets having accidents in residents rooms or beds. During the tour, LPA did not detect a foul odor in the MC bedrooms or hallways. Six (6) residents in AL were identified to have pets in the facility. LPA conducted three (3) AL resident interviews due to the other three (3) residents being unavailble during LPA's visit. Three (3) AL residents interviews revealed their pets do not urinate or defecate on their beds and are conditioned to toilet in a designated area inside their room. Three (3) AL residents interviewed reported there is not a foul odor in their room. A staff interviewed reported they have never observed or learned that pets have urinated or defecated on residents' beds or in unwanted areas in their rooms. During the tour, LPA did not detect a foul odor in the AL hallways or in the rooms of the residents interviewed. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. An exit interview was conducted and a copy of this report was reviewed and provided to ALC Villafana.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

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 4