331880776-1-30-2024-18-AS-KCLS-CZZN92-20240131091512

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 01/30/2024
Date Signed: 01/30/2024 04:29:34 PM

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
06/30/2020 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200630082903

FACILITY NAME:	WESTMONT VILLAGE		FACILITY NUMBER:	331880776
ADMINISTRATOR:	KURT KNAUER		FACILITY TYPE:	740
ADDRESS:	17050 ARNOLD DRIVE		TELEPHONE:	(951) 697-2100
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92518
CAPACITY:	225	CENSUS: 189	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Monya Henry, Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff member steals resident's money

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegation. LPA Prieto met with Executive Director Henry and explained the elements of the complaint.

Regarding the allegation that staff member steals resident's money: LPA Prieto interviewed staff #1, who confirmed that resident #1 (R1), in question, does reside in the assisted living portion of the facility, but has not been notified of monies being stolen from R1.
Witness (W1) to R1's statement was not provided with an alleged perpetrator's name, date of event, location of thief or amount of money that was allegedly stolen.
****Continued on LIC 9099C****

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: 9512480349(323) 981-3968
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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-20200630082903

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: 01/30/2024

NARRATIVE

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LPA Prieto attempted to interview R1, in question, without success. S1 confirmed that R1 has left Westmont Village, to a medical facility not licensed by State Licensing and will not be returning.

Based on the information obtained there is not enough evidence that staff member steals resident's money. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

This report was signed by LPA Prieto and Executive Director Henry and a copy was left with the facility.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: 9512480349(323) 981-3968
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

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