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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 01/10/2024
Date Signed: 01/10/2024 04:18:17 PM

Substantiated


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
01/02/2024 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20240102154208
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: 189DATE:
01/10/2024
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Monya Henry, Executive DirectorTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Facility is not maintained in good repair.
INVESTIGATION FINDINGS:
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On 1/10/2024, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegation. LPA met with Executive Director, Monya Henry who was informed of the purpose of the visit. At the time of visit, LPA interviewed staff, interviewed residents, and conducted an inspection of the facility.
Regarding the allegation “Facility is not maintained in good repair” it was alleged that an elevator and double door in the assisted living section in the facility is in disrepair. Staff were interviewed who reported the double door was never in disrepair but the elevator broke in December 2023 and is in the process of being repaired. Staff stated facility has another elevator by the end of the building for residents to use. Residents were interviewed who reported the elevator has been in disrepair for over a month. Residents stated facility has another elevator, however the elevator is located at the end of the building and it’s hard for the residents to do the long walk to the elevator and it's hard for residents on wheelchair to wheel themselves to dinning. LPA conducted a facility inspection including the mentioned double door and elevator and observed the double door to be operating without issues. The elevator was observed to still be out of service.
Based on LPA's observations, and interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division & Chapter number 6) are being cited on the attached LIC9099D). An exit interview was conducted, and a copy of this report was reviewed with and provided along with appeal rights to Monya Henry.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
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 3
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
01/02/2024 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20240102154208

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: 189DATE:
01/10/2024
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Monya Henry, Executive DirectorTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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9
Facility does not conduct fire drills.
INVESTIGATION FINDINGS:
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On 1/10/2024, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegation. LPA met with Executive Director, Monya Henry who was informed of the purpose of the visit. At the time of visit, LPA interviewed staff, interviewed residents, and reviewed facility records.
Regarding the allegation “Facility does not conduct fire drills”, staff were interviewed who reported facility conducts fire drills monthly. Staff reported fire drill are conducted with staff only. Residents were interviewed who reported facility turns on the fire alarm once in a while but weren’t told if it was for fire drills. LPA reviewed facility fire drill records and observed the last fire drill was conducted on 11/30/2023.
Based on interviews and file review, there is not enough evidence to support the above allegation. 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, therefore the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Monya Henry.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240102154208
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/19/2024
Section Cited
CCR
80087(a)
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Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
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Executive Director stated the elevator will be repaired and proof provided to LPA by the POC due date 1/19/2024.
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This requirement is not met based as evidence by observation and interview. The licensee did not comply by having the elevator in disrepair for over a month which poses a potential health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3