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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 11/26/2024
Date Signed: 11/26/2024 04:00:56 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
10/10/2024 and conducted by Evaluator Sara Martinez
COMPLAINT CONTROL NUMBER: 18-AS-20241010091534
FACILITY NAME:WESTMONT OF RIVERSIDEFACILITY NUMBER:
331880776
ADMINISTRATOR:MONYA HENRYFACILITY TYPE:
740
ADDRESS:17050 ARNOLD DRIVETELEPHONE:
(951) 697-2100
CITY:RIVERSIDESTATE: CAZIP CODE:
92518
CAPACITY:225CENSUS: 158DATE:
11/26/2024
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Sheryl McCaskill - Operational SpecialistTIME COMPLETED:
04:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility neglected the care of a Resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to conclude the complaint investigation regarding the allegation listed above. LPA was granted entry and met with Operational Specialist Sheryl McCaskill who was informed of the purpose for the visit. The investigation consisted of observations, interviews, and records review.

Regarding the allegation “Facility neglected the care of a Resident”, it was reported on 10/09/2024 at approximately 11:15am, Resident One (R1) had an unwitnessed fall and was found on the floor in R1’s apartment soaked in urine. Staff One (S1) responded to the call button request for R1 and assisted R1 off the floor with help from Staff Two (S2) and two (2) additional relevant parties. R1 reported to relevant parties that R1 was on the floor since the night prior and was unaware of how R1 ended up on the floor. Interview conducted with Staff (S3) reported upon admission, R1 was assessed as a Level 1 care and did not need medication management or assistance with his activities of daily living (ADL). Interviews conducted with S1 revealed R1 does not require assistance or supervision with their activities of daily living (ADL).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
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-20241010091534
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 OF RIVERSIDE
FACILITY NUMBER: 331880776
VISIT DATE: 11/26/2024
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
S1 reported they had conducted a safety check on the morning of 10/09/2024 and observed R1 in bed sleeping. Interview conducted with R1 reveled they were not sure how long they were on the floor after they slipped off their recliner in their apartment. R1 reported they were on the floor for approximately “30 to 45 minutes”. R1 reported they feel safe living at the facility. R1 stated “staff are always taking care of me, feeding me, and every time I call staff they come”. LPA conducted a record review of R1’s Service Plan dated 08/15/2024 has R1’s care level set at Level 1. Service Plan reveals R1 is independent and does not require assistance with "Dressing", "Grooming", "Oral Care", "Toileting", "Transfer", "Mobility", and "Medication Management". Record review of R1’s physician’s report dated 06/27/2024 reveals R1 is able to bathe self, able to groom self, able to feed self, able to care for toileting needs, able to manage and store own medication, and able to administer own medication. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted and a copy of this report was provided to Operational Specialist Sheryl McCaskill.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2