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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 07/22/2020
Date Signed: 07/22/2020 11:35:05 AM



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
07/13/2020 and conducted by Evaluator Javier Prieto
COMPLAINT CONTROL NUMBER: 18-AS-20200713101950
FACILITY NAME:WESTMONT VILLAGEFACILITY NUMBER:
331880776
ADMINISTRATOR:KURT KNAUERFACILITY TYPE:
740
ADDRESS:17050 ARNOLD DRIVETELEPHONE:
(951) 697-2100
CITY:RIVERSIDESTATE: CAZIP CODE:
92518
CAPACITY:225CENSUS: DATE:
07/22/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kurt KnauerTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff is not abiding to Admission Agreement
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto contacted the facility Executive Director Kurt Knauer, via telephone and email, due to COVID-19 social distancing, to conclude a complaint investigation. LPA Prieto identified himself and discussed the purpose of the call and the elements of the allegation. Allegation of staff not abiding to Admission Agreement, pertains to resident #1 (R1) submitting a 30 day notice to leave facility. Interviews with staff state the 30 day notice was received and honored. Staff states resident moving staff are limited in entering the facility due to COVID 19 visitation restrictions. Administrator made arrangements with R1 to have belonging moved from R1 apartment to outside of facility for movers to then transfer belongings to moving transport. Interview with witness and resident also stated a 30 day notice was submitted months prior, but R1 could not move out of facility as new destination are experiencing COVID positive residents. R1 was not asked to leave and waited at Westmont until safe to move into a COVID free facility. Witness and R1 have made arrangements to move R1 belongings with facility staff, R! family and movers cooperation and precautions to COVID 19 safety,
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2020
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-20200713101950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WESTMONT VILLAGE
FACILITY NUMBER: 331880776
VISIT DATE: 07/22/2020
NARRATIVE
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Based on the information obtained there is not enough evidence that staff is not abiding to Admission Agreement. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A copy of this report was signed by LPA Prieto, and emailed to facility Administrator for signature. A copy of this report is kept at Licensing office.

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2020
LIC9099 (FAS) - (06/04)
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