<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 08/07/2023
Date Signed: 08/07/2023 12:24:41 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
08/02/2023 and conducted by Evaluator Sara Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230802130435
FACILITY NAME:WESTMONT VILLAGEFACILITY NUMBER:
331880776
ADMINISTRATOR:PATRICK FRAZERFACILITY TYPE:
740
ADDRESS:17050 ARNOLD DRIVETELEPHONE:
(951) 697-2100
CITY:RIVERSIDESTATE: CAZIP CODE:
92518
CAPACITY:225CENSUS: 172DATE:
08/07/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monya Henry - Executive DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff attempted to change resident's medical insurance without authorized representative's consent.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sara Martinez made an unannounced visit to initiate an investigation into the above allegation. LPA met with Executive Director Monya Henry and informed her of the purpose of the visit. LPA collected and reviewed documentation, conducted staff interview and conducted a tour of the facility.

Regarding the allegation "Staff attempted to change resident's medical insurance without authorized representative's consent", Resident One's (R1) representative received a call from an Eligibility Representative from Senior Doc inquiring about changing R1's medical provider to a provider is affilated with the facility. LPA found during the conversation with R1's representative they were concerned that improper activities regarding R1's care and service was taken place. LPA's interview process revealed after further research, the family member and resident agreed to switch to the facility’s affiliated medical provider and that the activities were not fraudulent and agreed with the resident's service and needs.

*CONTINUED ON 9099-C*
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
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 3
Control Number 18-AS-20230802130435
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WESTMONT VILLAGE
FACILITY NUMBER: 331880776
VISIT DATE: 08/07/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
After speaking with the Executive Director it was explained to LPA that Staff One (S1) presenting the insurance information did it out of context which caused miscommunication with R1's representative. LPA was informed regarding S1 and the status of their employment at this facility, there was a mutual agreement and S1 will no longer be working at the facility after 08/08/2023. Thus, this allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted where a copy of this report was discussed and provided to Executive Director Monya Henry along with a copy of the LIC811 (confidential names list).
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
08/02/2023 and conducted by Evaluator Sara Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230802130435

FACILITY NAME:WESTMONT VILLAGEFACILITY NUMBER:
331880776
ADMINISTRATOR:PATRICK FRAZERFACILITY TYPE:
740
ADDRESS:17050 ARNOLD DRIVETELEPHONE:
(951) 697-2100
CITY:RIVERSIDESTATE: CAZIP CODE:
92518
CAPACITY:225CENSUS: 172DATE:
08/07/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monya Henry - Executive DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not providing authorized representative with an itemized list of charges
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sara Martinez made an unannounced visit to initiate an investigation into the above allegation. LPA met with Executive Director Monya Henry and informed her of the purpose of the visit. LPA collected and reviewed documentation, conducted staff interview and conducted a tour of the facility.

Regarding the allegation "Staff are not providing authorized representative with an itemized list of charges", LPA conducted interviews and record review and found that the itemized list of charges for July 2023 was sent and received on 08/02/2023. During the visit, LPA inquired about the delayed invoice with the Executive Director and she stated they had the wrong email on file and had corrected the issue and informed Resident One (R1) representative. Thus, this complaint was 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 where a copy of this report was discussed with and provided to Executive Director Monya Henry.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
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 3