331880776-6-2-2023-18-AS-JESL-CTA6WZ-20230629211110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 06/02/2023
Date Signed: 06/02/2023 01:42:35 PM

Unsubstantiated

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
05/26/2023 and conducted by Evaluator Jesse Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230526163516

FACILITY NAME:	WESTMONT VILLAGE		FACILITY NUMBER:	331880776
ADMINISTRATOR:	PATRICK FRAZER		FACILITY TYPE:	740
ADDRESS:	17050 ARNOLD DRIVE		TELEPHONE:	(951) 697-2100
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92518
CAPACITY:	225	CENSUS: 178	DATE:	06/02/2023
		UNANNOUNCED	TIME BEGAN:	10:34 AM
MET WITH:	Sheila Dudley, Regional Sales Specialist		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Licensee does not provide enough staff to meet resident needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jesse Gardner made an unannounced visit to initiate an investigation into the above allegation. LPA met with Regional Sales Specialist Sheila Dudley, who was informed of the purpose of the visit. LPA collected documentation, and conducted a tour of the facility. On the day of visit, the Department reviewed records, conducted staff and resident interviews, and made observations.

It was alleged that on May 25, 2023 between the hours of 1:30pm-3:30pm, there were no staff in Assisted Living.

Continue on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

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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Control Number 18-AS-20230526163516

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: WESTMONT VILLAGE	FACILITY NUMBER: 331880776
	VISIT DATE: 06/02/2023

NARRATIVE

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LPA interviewed Resident Services Director (RSD) Mayra Alfaro (via telephone). Interview revealed that on a fully staffed day, there are 2 medical technician's and 3 caregivers for morning shift (6am-2pm), 2 medical technician's and 3 caregivers for afternoon shift (2pm-10pm), and 1 medical technician and 1 caregiver for night shift (10pm-6am).

Interview with RSD revealed that on the day of allegation, 2 caregivers had called off, 1 was off for vacation, and 1 had a no-call no-show for their shift. 2 caregivers were brought in from a staffing agency, 1 worked a double shift, and 2 were brought in from memory care totalling 5 caregivers for Assisted Living. 5 staff to care for 38 residents who reside in Assisted Living (where the complaint was centralized). LPA reviewed records and conducted separate staff interviews confirming RSD's statement.

LPA then interviewed residents and found that although staffing might have needed to be reshuffled on the day of allegation, residents in Assisted Living did not notice a shuffle in staff, and had no concern of care being provided. Additionally, residents who were interviewed stated that they don't usually have to push their pendants, that staff are attentive to their needs and check on them regularly. If they need to utilize their pendants, staff are prompt in their response. Finally, LPA observed plenty of staff throughout the facility assisting residents in a multitude of ways. Thus, this allegation was Unsubstantiated.

An exit interview was conducted with Regional Sales Specialist Sheila Dudley, where a copy of this report was discussed and provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

LIC9099 (FAS) - (06/04)

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