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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880776
Report Date: 09/11/2023
Date Signed: 09/11/2023 12:54:27 PM


Document Has Been Signed on 09/11/2023 12:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 VILLAGEFACILITY NUMBER:
331880776
ADMINISTRATOR:MONYA HENRYFACILITY TYPE:
740
ADDRESS:17050 ARNOLD DRIVETELEPHONE:
(951) 697-2100
CITY:RIVERSIDESTATE: CAZIP CODE:
92518
CAPACITY:225CENSUS: 180DATE:
09/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator Monya HenryTIME COMPLETED:
01:00 PM
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On 9/11/2023, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA met with Administrator Monya Henry who was informed of the purpose of the visit.

LPA toured the facility’s interior and exterior with Administrator Henry. The facility is approved to care for 225 non-ambulatory elderly residents, of which 25 may be bedridden. The facility also has a hospice waiver for 25 and is approved for delayed egress. LPA was informed that the facility currently has 71 residents residing in the assisted living units, 34 in memory care, and 75 living independently.

LPA observed the facility has charged fire extinguishers, operating fire alarm systems, and carbon monoxide detectors. Outdoor and indoor passageways were kept free of obstruction. Outside shaded seating areas are available for the residents in care. Cleaning supplies, medications, knives, and sharp instruments are locked and inaccessible to the residents. Medications were stored in the medication carts and wellness rooms. LPA toured the kitchen. Food was stored in a safe and healthful manner. The facility had a menu available for review, which also offers alternative meal options. LPA observed that the facility had a two (2) day supply of perishable food items and seven (7) day supply of nonperishable food items. LPA toured a sample of the resident rooms. LPA observed the facility had delayed egress in the memory care unit. The resident bedrooms had the required furniture and functional lighting.

Continued on LIC809-C..
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/11/2023
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Continued from LIC809..

LPA tested the call pendant system in the resident rooms and observed that the facility staff responded within ten (10) minutes. LPA observed grab bars and nonskid mats in the bathrooms. LPA conducted staff and resident interviews. Staff interviewed had a criminal background clearance on file and were associated to the facility. LPA was informed the last disaster drill was held on 8/31/2023 and fire drill 8/29/2023.

During today’s visit, LPA did not observe any deficiencies. An exit interview was conducted where this report was discussed and provided to the Administrator Henry.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2