331880776-6-22-2025-18-AS-RORN-DHZKPZ-20250626080532

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 06/22/2025
Date Signed: 06/22/2025 12:39:07 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
11/14/2022 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221114094514

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: 157	DATE:	06/22/2025
		UNANNOUNCED	TIME BEGAN:	07:59 AM
MET WITH:	Alicia Ballard/Memory Care Director		TIME COMPLETED:	12:38 PM

ALLEGATION(S):

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Facility staff does not provide a safe environment for residents in care.
Facility staff are not adequately trained.

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), Residents Interviews (R#1-R#13) and Staff Interview (S#1-S#5). LPA obtained and reviewed the following documents: Resident Roster dated: 6/21/25, Staff Roster dated: 6/17/25, Copies of Staff Training Modules such as: Providing Medication Assistance-California, Medication Management Medications, Managing Medications in Assistant Living Facilities(ALFs): Helping with self-administration, Managing Medications in (ALFs), Antipsychotic and Beyond and Polypharmacy: Monitoring Medications dated: 5/15/25, and a Health and Safety Check of the facility.

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-20221114094514

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: Facility staff does not provide a safe environment for residents in care.

The details of the complaint alleged that facility staff did not provide a safe environment for (R#1).

On June 21, 2025, at approximately 4:00 p.m., LPA Iniguez performed a health and safety check at the facility. LPA Iniguez did not observe any immediate or potential dangers to the residents in care.

On June 21, 2025, at approximately 10:00 AM, during an interview with the Executive Director (A#1), she stated that the facility staff are trained on residents' rights and work to provide a healthy and safe environment for (R#1) as well as all other residents in their care.

On June 21 and 22, 2025, at approximately 10:00 AM, during interviews with residents (R#1-R13), (12) out of (13) stated that they believe the facility staff is trained in residents' rights and they strive to keep a healthy and safe environment. Additionally, (12) out of (13) residents in care stated feeling safe in the facility.

On June 21, 2025, at approximately 02:00 PM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that they are trained on resident’s rights, and they take the training every year. Additionally, (5) out of (5) facility staff members stated that they are providing a healthy and safe environment for all residents in their care.

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-20221114094514

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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Allegation: Facility staff are not adequately trained.

The details of the complaint alleged that facility staff are not trained on how to handle resident’s medications.

On June 22, 2025, at approximately 10:00 AM, during a records review, LPA Iniguez observed the facility MedTech’s training dated:5/15/25, such as Providing Medication Assistance-California, Medication Management Medications, Managing Medications in Assistant Living Facilities (ALFs): Helping with self-administration, Managing Medications in (ALFs), Antipsychotic and Beyond and Polypharmacy: Monitoring Medications. In addition, LPA Iniguez observed that these trainings are conducted annually as part of their mandatory training.

On June 21, 2025, at approximately 10:00 AM, during an interview with the Executive Director (A#1), she stated that the facility's MedTechs undergo mandatory annual training as well as on-the-job training. Additionally, (A#1) mentioned that the MedTechs are trained to handle the medications of resident (R#1) and all other residents in the care facility.

On June 21 and 22, 2025, at approximately 10:00 AM, during interviews with residents (R#1-R13), (12) out of (13) stated that they think the facility staff responsible for managing medications are properly trained in handling their medications and those others.

On June 21, 2025, at approximately 02:00 PM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that the facility staff that handles residents' medications are the Medtechs and they get trained every year as part of their mandatory training.

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-20221114094514

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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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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