331880776-6-22-2025-18-AS-RORN-DHZSYQ-20250626141756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 06/22/2025
Date Signed: 06/22/2025 12:35:38 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
10/14/2021 and conducted by Evaluator Regina Cloyd

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211014112239

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: 197	DATE:	06/22/2025
		UNANNOUNCED	TIME BEGAN:	08:04 AM
MET WITH:	Memory Care Director Alicia Ballard		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility required resident to pay for exterminator services.
Staff handles residents roughly.
Staff speak inappropriately to resident.
Staff do not respond to residents call button timely.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/14/2021, Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to initiate a complaint investigation into the allegations list above. LPA met with Executive Director (ED) Keith Kasin. On 06/21/2025, LPA Regina Cloyd conducted a subsequent and met with staff. On 06/22/2025, LPA Cloyd conducted a subsequent. LPA met with Memory Care Director Alicia Ballard and the purpose of the visit was explained.
Investigation consisted of the following: On 10/14/2021, LPA toured the facility with Resident Services Director (RSD) Deserie Rodillo and interviewed one (1) staff and three (3) residents. LPA also obtained copies of pertinent documents and records. RSD was advised that at this time, the complaint requires further investigation which may include possible follow-up telephone calls, additional interviews, or visits before reaching investigation findings. On 06/17/2025, LPA received an electronic copy of the Personnel Record (06/17/2025) and Register of Residents (printed 06/17/25). On 06/18/25, LPA retrieved Departmental records (interview notes with Resident #2 – Resident #4 and with Staff #3 and Resident #1’s Face Sheet) electronically. CONTINUE TO LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
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-20211014112239

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On 06/21/2025, LPA received the following records: Orkin Agreement (dated 06/29/2021), Resident #1 Residency Agreement and 2021 – 2022 Resident Detail Ledger, Resident #2 (R2) Face Sheet, and 14 staff training records. LPA also interviewed two (2) Witnesses, Staff and Residents. NOTE: As of 06/21/25, Residents #1 – 4 no longer live at the facility and Staff #1 – 4 no longer work at the facility. R1 is deceased. On 06/22/2025, LPA called ten residents and was able to interview five (5) residents. NOTE: LPA unable to interview Staff #1 and Staff #2.

Investigation revealed the following:
Regarding the allegation, “Facility required resident to pay for exterminator services,” it is alleged that Staff #4 required Resident #1 (R1) had to pay $2,000 for exterminator services. Orkin Agreement revealed that the facility received pest and fly control services four times per month for one year. Executive Director (S5) was unable to provide invoice for services rendered for R1. R1’s Detailed Ledger did not reveal pest control charges from 09/2021 – 12/2021. R1’s Residency Agreement (Section H(2)) revealed resident agree to maintain their apartment in a clean, sanitary and orderly condition. Resident shall be responsible for any loss or damage that resident or their guests cause to their apartment or other property of the community, or to other residents and their property, unless due to ordinary wear and tear (page 17). Interview with Witness #1, R1’s son, indicated W1 does not recall paying for exterminator services but purchased R1 a new bed. Interview with S13 indicated that R1 did not pay for exterminator services but R1 mentioned having to purchase new furniture and a new bed. S13 indicated that the rooms below and above was also treated. S5, S9 indicated that the facility pays for bed bug treatments. S10 indicated there aren’t any bed bugs but ants are reported to maintenance. S6 – S8, S12 are unaware whether the facility or the resident pays for exterminator services. R5 indicated that R5 purchases own products. Interview with R7 – R12 indicated that they do not pay for exterminator services.

Regarding the allegation, “Facility required resident to pay for exterminator services,” based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

CONTINUE TO LIC9099-C.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
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-20211014112239

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff handles residents roughly.

Regarding the allegation, “Staff handles residents roughly,” it is alleged that Staff #1 (S1) yanked Resident #2 (R2) top off and R2’s head flew back. It also alleged that S1 was rough with Resident #3 (R3) while dressing. It is alleged that Staff #2 (S2) informed Staff #3 (S3) and Staff #4 (S4). Resident #2 - 4 indicated (source: departmental records) that staff does not handle them roughly. R3 indicated that staff was a little rough one time when taking R3’s shirt off. It tugged on R3’s ear. Six (6) out of six (6) resident (R6 – R10, R12) interviews denied that staff handles them roughly. Two (2) out of two (2) resident (R5 and R11) indicated that staff does not provide assistance with dressing and grooming. S3 (source: departmental records) denied the allegation. Six (6) out of eight (8) staff (S4-S10, S12) interviews denied that staff handles residents roughly. Training records revealed that fourteen (14) out of fourteen (14) staff had completed the Resident Rights training.

Regarding the allegation, “Staff handles residents roughly,” based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

Allegation: Staff speak inappropriately to resident.

Regarding the allegation, “Staff speak inappropriately to resident,” it is being alleged that Staff #1 (S1) called Resident #3 (R3) an inappropriate name. Resident #2 - 4 indicated (source: departmental records) that staff does not call them by inappropriate names. R5 – R12 indicated staff does not speak inappropriately to residents. S3 (source: departmental records) denied the allegation. Nine (9) out of nine (9) staff (S4 – 10, S12 – S13) interviews denied the allegation. Training records revealed that fourteen (14) out of fourteen (14) staff had completed the Resident Rights training.

Regarding the allegation, “Staff speak inappropriately to resident,” based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. CONTINUE TO LIC9099-C.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
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-20211014112239

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff do not respond to residents call button timely.
Regarding the allegation, “Staff do not respond to residents call button timely,” it is being alleged that Resident #4 (R4) fell, used the call button, and staff did not check on R4. Departmental records revealed that R4 indicated that R4 did not activate the call button and was on the floor for about 30 minutes. R4 indicated that staff always come right away when called. Resident #2 indicated that the response time depends on the shift (mornings, evenings, and overnight). Resident #3 indicated that it takes about 30 minutes for staff to respond to call button. Three (3) out of four (4) resident (R5, R7, R8, R9) interviews indicated staff respond to residents call button in a timely manner. R6 and R12 indicated they do not call for assistance. R11 indicated that R11 could not provide a definitive answer. Seven (7) out of seven (7) staff (S5, S7 – S8, S10 – S13) interviews denied the allegation. S6 and S9 indicated that memory care does not have call buttons. S6 indicated rounds are conducted every two hours and residents are in the common areas when they are awake.

Regarding the allegation, “Staff do not respond to residents call button timely,” based on interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiencies were cited.

An exit interview was conducted and a copy of this report was provided to the Memory Care Director Alicia Ballard.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
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: 4 of 4