331880776-8-8-2024-18-AS-RSTS-D8KV5Y-20240828160841

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 08/08/2024
Date Signed: 08/08/2024 11:01:46 AM

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
08/01/2024 and conducted by Evaluator Stephanie Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240801090923

FACILITY NAME:	WESTMONT OF RIVERSIDE		FACILITY NUMBER:	331880776
ADMINISTRATOR:	MONYA HENRY		FACILITY TYPE:	740
ADDRESS:	17050 ARNOLD DRIVE		TELEPHONE:	(951) 697-2100
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92518
CAPACITY:	225	CENSUS: 112	DATE:	08/08/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Monya Henry, Executive Director		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Staff did not ensure resident was administered their medication as needed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegation. The LPA met with Executive Director (ED), Monya Henry, after the start of the visit. The LPA informed Henry of the purpose for the visit.

A report was received by the Department alleging a temporarily contracted employee, Staff One (S1), of the facility denied medication administration to Resident One (R1) on 07/19/2024. The investigation included staff and resident interviews, a review of records, and collection of relevant documentation. One staff interview revealed R1 does not receive medication assistance from the facility. A letter from R1's medical provider revealed an order for R1 to begin self-administration of medications as of 04/01/2024. R1 was interviewed and confirmed the facility does not administer their medications. R1 reported their medications were delivered to the facility and S1 refused to retrieve the medications and bring them to the resident. R1's statement was conflicting; R1 later reported in the interview that S1 was already in possession of the medications and refused to provide them to the resident. R1 could not provide information on how they knew S1 was in possession of

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

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-20240801090923

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: 08/08/2024

NARRATIVE

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the medications. A facility director was interviewed and reported S1 is an employee of a staffing agency and was contracted to provide services on 07/19/2024. S1 could not be reached prior to the conclusion of the investigation. An interview was conducted with a facility employee who worked with S1 and revealed S1 did report they received the delivery, and they did not know if the resident was allowed to self-administer their medications. Per staff, S1 reported they later delivered the medications to S1, on the same day, once realizing the resident could self-administer. R1 reported they believed they did later receive their medications. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

This report was reviewed with ED Henry and a copy was provided.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

LIC9099 (FAS) - (06/04)

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