331880776-8-9-2023-18-AS-MVAO-CV2MZ8-20230825100240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 05/05/2022
Date Signed: 08/09/2023 09:33:16 AM

Unsubstantiated

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
05/03/2022 and conducted by Evaluator Jesse Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220503123616

FACILITY NAME:	WESTMONT VILLAGE		FACILITY NUMBER:	331880776
ADMINISTRATOR:	KEITH KASIN		FACILITY TYPE:	740
ADDRESS:	17050 ARNOLD DRIVE		TELEPHONE:	(951) 697-2100
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92518
CAPACITY:	225	CENSUS: 140	DATE:	05/05/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Maria Rossi, Regional Director of Operations		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Residents do not have access to a telephone
Facility is in disrepair
Facility is not abiding by admissions agreement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Jesse Gardner, conducted an unannounced visit to the facility to initiate the investigation into the above allegations. LPA met with Business Office Manager Josephine Williams, and informed her of the purpose of the visit.

LPA reviewed documents, and interviewed 14 residents, R1, R2, R3, R4, R5, R6, R7, R8. R9. R10. R11, R12, R13, R14, and S1.

It was alleged that on 4/30/22 at 8AM, the TV and internet service were turned off for all the residents, and some residents who had land line phones were affected. LPA conducted interviews, reviewed facility documentation, and toured the facility.
Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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-20220503123616

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: 05/05/2022

NARRATIVE

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It was alleged that a fire took place in a home, and as a result, a resident was unable to utilize their phone. According to interview with staff, a fire did in fact take place, it occurred at an area that is not licensed with Community Care Licensing. In as much as that internet providers were being evaluated for change; this only affected the independent area that is not licensed with Community Care Licensing (CCL). Interviews with residents in the Assisted Living community reported no loss of phone services, and all resident interviews reported that their phone lines were working without interruption. In addition to resident personal wired phones within their rooms, LPA observed that there is additional phone access provided by a hanging wall phone within the facility provided to all residents. As such the allegation is deemed as Unsubstantiated.

It was alleged that toilets and stoves were not working as intended. LPA reviewed facility documentation, conducted interviews and toured the facility. It was reported that the stove cooks at a temperature lower than it should, and the toilet takes 5 flushes to work. During LPA's tour of the facility, and while interviews were conducted, LPA found that the rooms that had their own stoves were operational. Additionally, LPA randomly checked resident toilets and found no issue with the function of said toilets. All toilets seemed to flush regularly and without having to flush more than once. Thus, this allegation was deemed Unsubstantiated.

It was alleged that admissions agreement stated that the facility would provide internet and TV service for $99 a month through a service provider. Through interviews conducted at the facility with residents, LPA found that although the facility administrator was changing internet providers, it only affected the residents in the independent area that is not licensed with CCL. The residents in the Assisted Living (AL) area that is licensed with CCL did not have any issues accessing their internet and had full phone service. Residents in the AL side of the facility did not have any issues to mention regarding the admission agreement. As such, the allegation that residents had issues with the admission agreement is Unsubstantiated.

A finding of UNSUBSTANTIATED means that 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.

An exit interview was conducted and a copy of this report was discussed with and provided to Business Office Manager Josephine Williams along with a copy of the LIC811.

This is an amended version of the original report dated 5/5/2022.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC9099 (FAS) - (06/04)

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