331880776-6-22-2025-18-AS-RORN-DHYUTL-20250625155208

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 06/22/2025
Date Signed: 06/22/2025 12:38:32 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
03/18/2022 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220318110117

FACILITY NAME:	WESTMONT VILLAGE		FACILITY NUMBER:	331880776
ADMINISTRATOR:	KEITH KASIN		FACILITY TYPE:	740
ADDRESS:	17050 ARNOLD DRIVE		TELEPHONE:	(951) 697-2100
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92518
CAPACITY:	225	CENSUS: 35	DATE:	06/22/2025
		UNANNOUNCED	TIME BEGAN:	07:58 AM
MET WITH:	Alicia Ballard/Memory Care Director		TIME COMPLETED:	12:38 PM

ALLEGATION(S):

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Staff inappropriately pulled on a resident while in care.
Staff did not address a resident's change in medical condition.

INVESTIGATION FINDINGS:

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On 6/22/2025 at approximately 8:30 AM, LPA Alfonso Iniguez conducted a subsequent unannounced complaint visit. LPA Iniguez met with Alicia Ballard/Memory Care Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Executive Director Interview (A#1), Witness Interview (W#1), Residents Interviews (R#1-R#5) and Staff Interview (S#1-S#3). LPA obtained and reviewed the following documents: Resident Roster dated: 6/21/25, Staff Roster dated: 6/17/25 and Copies of Staff Training Modules regarding Residents Personal Rights, First Aid, and CPR dated: 5/15/25.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: (707) 291-8399
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2025

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 4

Control Number 18-AS-20220318110117

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
	VISIT DATE: 06/22/2025

NARRATIVE

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Investigation Revealed the Following:

Allegation: Staff inappropriately pulled on a resident while in care.

The details of the complaint alleged that facility staff inappropriately pulled (R#1)’s arm.

On June 22, 2025, at approximately 9:00 a.m., LPA Iniguez conducted a records review and examined copies of staff training modules in Relias, dated May 15, 2025. It was noted that facility staff receives annual training on the “Essentials of Resident Rights.” Additionally, LPA Iniguez observed other trainings, including “Person-Centered Care in Assisted Living,” that are also taken annually.

On June 21, 2025, at approximately 11:00 AM, during an Interview with the Executive Director (A#1), she stated that facility staff are trained on residents' rights, and they receive training every year. Also, (A#1) stated that to her knowledge, facility staff did not pull (R#1) arm or any other resident in care in an inappropriate way.

On June 21, 2025, at approximately 8:30 AM, during a telephone conversation with (W#1), LPA Iniguez asked (W#1) whether they had ever witnessed (R#1) being mistreated by facility staff or being pulled by their arm. (W#1) responded that they had not witnessed any such behavior during their visits to the facility.

On 6/21/25, at approximately 10:00 AM, Licensing Program Analyst-LPA Alfonso Iniguez was not able to spoke with (R#1) since they are no longer living at the facility.

On June 21, 2025, at approximately 10:00 AM, during interviews with residents (R#2-R#5), (4) out of (4) stated that they think the facility staff is trained on resident’s rights and they have never been pulled inappropriately by them.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: (707) 291-8399
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 18-AS-20220318110117

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
	VISIT DATE: 06/22/2025

NARRATIVE

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On June 21, 2025, at approximately 11:00 AM, during interviews with facility staff (S#1-S#3), (3) out of (3) stated that they are trained on resident’s rights, and they get trained every year. In addition, (3) out of (3) facility staff stated that they have never pulled (R#1)’s arm or any other resident in care inappropriately.

Allegation: Staff did not address a resident's change in medical condition.

The details of the complaint alleged that facility staff made fun of resident when they requested medical attention.

On June 22, 2025, at approximately 9:00 a.m., LPA Iniguez conducted a records review and examined the copies of staff training modules in Relias. During the review, LPA Iniguez noted that facility staff had received training on "First Aid, Workplace Emergencies, and Natural Disasters: An Overview." Additionally, LPA Iniguez observed that CPR training was also listed.

On June 21, 2025, at approximately 11:00 AM, during an Interview with the Executive Director (A#1), she stated that the facility staff are trained in first aid and CPR, (A#1) stated that they renew their training every two years. In addition, (A#1) stated that she has never observed facility staff making fun of residents in care when they request medical attention.

On June 21, 2025, at approximately 8:30 AM, during a telephone conversation with (W#1), (W#1) mentioned that the staff was always excellent with (R#1) and the other residents and that they never saw any staff members making fun of (R#1) or any other resident in care.

On 6/21/25, at approximately 10:00 AM, Licensing Program Analyst-LPA Alfonso Iniguez was not able to spoke with (R#1) since they are no longer living at the facility.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: (707) 291-8399
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 18-AS-20220318110117

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
	VISIT DATE: 06/22/2025

NARRATIVE

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On June 21, 2025, at approximately 10:00 AM, during interviews with residents (R#2-R5), (4) out of (4) stated that they think the facility staff is trained regarding medical emergencies. Additionally, (4) out of (4) residents in care state that the facility staff have not made fun of them when they requested medical attention.

On June 21, 2025, at approximately 11:00 AM, during interviews with facility staff (S#1-S#3), (3) out of (3) stated that they are trained in first aid and CPR in case of a medical emergency, and they renew their training every two years. Additionally, (3) out of (3) facility staff stated that they had never made fun of any resident in care when they requested medical attention.

During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of the Complaint Report was given to Alicia Ballard/Memory Care Director.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: (707) 291-8399
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2025

LIC9099 (FAS) - (06/04)

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