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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880776
Report Date: 09/29/2026
Date Signed: 09/29/2026 04:50:14 PM

Document Has Been Signed on 09/29/2026 04:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 RIVERSIDEFACILITY NUMBER:
331880776
ADMINISTRATOR/
DIRECTOR:		MICHAEL FOUNTAINFACILITY TYPE:
740
ADDRESS:17050 ARNOLD DRIVETELEPHONE:
(951) 697-2000
CITY:RIVERSIDESTATE: CAZIP CODE:
92518
CAPACITY: 225CENSUS: 197DATE:
09/29/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Executive Director Michael FountainTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On 9/29/2026, Licensing Program Analyst's (LPA's) Valerie Flores and Jeffrey Thompson made an unannounced visit to the facility for the purpose of conducting the one-year annual inspection. LPA's met with Executive Director Michael Fountain and explained the purpose of the visit. A tour was conducted of the facility alongside Michael, where the following was observed:

The facility is a three-story structure with a secured memory care unit on the lower level. A random sampling of resident units were toured. Resident units in the assisted living portion of the facility were observed to be apartment style. Units styles varied from studio and two-bedrooms. Bedrooms were observed to be equipped with the required bedding, furniture, and functional lighting. The facility maintained a comfortable temperature for the residents. The facility kitchen area was observed to be sanitary and organized. The facility maintained a (2) two-day supply of perishable foods and (7) seven-day supply of non-perishable foods. Refrigerator and freezer temperatures were logged daily. The facility organizes plenty of activities to encourage resident socialization. The memory care unit was observed to have a sufficient supply of board games available to the resident and were observed to be age appropriate. The overall facility was observed to be in good repair. Emergency drills are conducted quarterly. Per Executive Director, there are no firearms and/or ammunition the premises.

LPA observed postings of the emergency disaster, infection control plan, Administrator Certification, LTCO information, and PUB 475. LPA's reviewed (14) Fourteen resident records. Records reviewed included admission agreement, medical assessment and TB test results, pre-admission appraisals, appraisal/needs and service plans, and personal rights notification. (10) Ten staff records were reviewed.

(Continue to LIC809C...)

Anthony Perez
Valerie Flores
DATE: 09/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 09/29/2026 04:50 PM - It Cannot Be Edited


Created By: Valerie Flores On 09/29/2026 at 04:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WESTMONT OF RIVERSIDE
FACILITY NUMBER: 331880776

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(c)(2)
Incidental Medical and Dental Care Services
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above as (2) two out of (2) two residents did not have prescribed PRN medication on hand which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2026
Plan of Correction
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Executive Director agreed to have the residents medications filled by 10/5/2026. Proof shall be submitted to LPA by Close of Business 10/5/2026. In addition, Medication Technician's will participate in an in-service training pertaining to identifying descrepancies in the MAR and ensuring medications are filled/refilled in a timely manner. Proof of training shall be submitted to LPA by Close of Business 10/20/2026 via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Anthony Perez
NAME OF LICENSING PROGRAM MANAGER:
Valerie Flores
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2026


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/29/2026
NARRATIVE
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(Continuation from LIC809)

Staff record reviewed included but not limited to valid first aid/CPR certification, background clearance, job application, health screening and TB test results, training verification, and current administrator certification. (3) Three resident medications and Medication Administration Records were observed. During a review, LPA Thompson observed that (2) two out of (3) three residents PRN medication were not on hand. Therefore, a deficiency will be issued in accordance to California Code of Regulations, Title 22.

An exit interview was conducted and a copy of this report was provided to the Executive Director.

***LPA's were off-site from 12:30PM-1:00PM***

NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Valerie Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2026
LIC809 (FAS) - (06/04)
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