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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800160
Report Date: 01/30/2024
Date Signed: 01/30/2024 04:42:01 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
01/10/2024 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20240110095337
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: 93DATE:
01/30/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Georgianna Mendez, Executive Director
Lyssa Irani, Community Resource Manager		TIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff do not have appropriate training.
Staff do not answer residents' call buttons in a timely manner.
INVESTIGATION FINDINGS:
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On 1/30/2024, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation to the allegations listed above. LPA met with Executive Director, Georgianna Mendez and Community Resource Manager, Lyssa Irani who were informed of the purpose of the visit. During the investigation, staff and residents were interviewed and facility records were reviewed.

Regarding the allegation “Staff do not have appropriate training”, staff were interviewed who reported staff are behind on training. LPA reviewed staff training log and observed some staff are missing some or haven’t received training (Substantiated).
Regarding the allegation “Staff do not answer residents' call buttons in a timely manner”, residents were interviewed who reported sometimes it takes staff long time to respond when resident calls for help. Staff were interviewed who denied that staff does not answer residents' call buttons in a timely manner.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
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 5
Control Number 18-AS-20240110095337
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: 01/30/2024
NARRATIVE
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Staff stated staff are required to respond to resident within 5 minutes of residents calling for help. LPA reviewed facility call log and observed some response time were over two to five hours (Substantiated).

Based on LPA’s observations, interviews conducted and record review, the preponderance of evidence standard has been met. Therefore, the above allegations are found to be substantiated. California Code of Regulations Title 22, Division & Chapter number 6 are being cited on the attached LIC9099D. An exit interview was conducted, and this reported was provided along with appeal rights to Georgianna Mendez.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
01/10/2024 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20240110095337

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: 93DATE:
01/30/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Georgianna Mendez, Executive Director
Lyssa Irani, Community Resource Manager		TIME COMPLETED:
04:20 PM
ALLEGATION(S):
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9
Facility is operating without an Administrator.
Facility heater units are in disrepair.
INVESTIGATION FINDINGS:
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On 1/30/2024, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation of the allegations listed above. LPA met with Executive Director, Georgianna Mendez and Community Resource Manager, Lyssa Irani who were informed of the purpose of the visit. During the investigation, staff and residents were interviewed and facility records were reviewed.
Regarding the allegation “Facility is operating without an Administrator”, it was alleged that facility doesn’t have an Administrator, since July 2023. Staff were interviewed who reported facility had an administrator who went on leave in July 2023 but resigned in October 2023. Another Administrator was hired in November 2023 but was later dismissed on 1/2/2024. Staff stated facility recently hired an Administrator who started on 1/24/2024. Staff stated in July 2023, in the absence of the Administrator, the facility had a designated person who was responsible and accountable for management and administration of the facility. Staff provided LPA with LIC308 Designation of Facility Responsibility form, dated 11/7/2022 showing Community Resource Manager as the Designated substitute in the absence of the Administrator (Unsubstantiated).
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20240110095337
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: 01/30/2024
NARRATIVE
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Regarding the allegation “Facility heater units are in disrepair” it was alleged that facility heater is broken. Staff were interviewed who stated that the heater in the memory care unit broke on 1/5/2024 but was repaired the same day. Residents were interviewed who stated the heater was broken few weeks ago but was fixed the same day. Staff provided LPA with the service order receipt that shows work was completed on 1/5/2024. LPA toured the facility including the memory care unit and observed the heater operating without issues (Unsubstantiated).

Based on interviews with staff and residents and LPA’s observation, there is not enough evidence to support the approve allegations. 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 allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Georgianna Mendez.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20240110095337
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: 01/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
Section Cited
CCR
87411(c)
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Personnel Requirements – General
(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69
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Executive Director stated staff will be trained and a proof of staff training will be provided to LPA by the POC due date 2/9/2024.
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This requirement is not met based as evidence by observation, interview, and record review. The licensee did not comply by having untrained staff assisting residents with personal activities of daily living which poses a potential health, safety or personal rights risk to persons in care.
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Type B
02/09/2024
Section Cited
CCR
87468.2(a)(4)
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Residents in All Facilities, shall have all of the following personal rights:
(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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Executive Director stated staff will be trained and a proof of staff training will be provided to LPA by the POC due date 2/9/2024.
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This requirement is not met based as evidence by observation, interview, and record review. The licensee did not comply by having staff not respond to residents in a timely manner which poses a potential health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5