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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880902
Report Date: 11/29/2022
Date Signed: 11/29/2022 12:19:02 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/25/2022 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220725131214
FACILITY NAME:BUENA VISTA ASSISTED LIVINGFACILITY NUMBER:
331880902
ADMINISTRATOR:NEWCOMB, DOLLYFACILITY TYPE:
740
ADDRESS:1393 S. BUENA VISTA ST.TELEPHONE:
(951) 658-5160
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:49CENSUS: 38DATE:
11/29/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Mariel Hernandez - MetTechTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Resident is being molested by another resident while in care

Staff are not meeting the care needs of resident(s) in care

Residents in care are being handled roughly by staff

Residents are being locked in their rooms while in care

INVESTIGATION FINDINGS:
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On today's date, Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of following up on an investigation with the above allegation. LPA Colvin met with MedTech Mariel Hernandez. Below is a summary of the findings of the investigation:

Regarding allegation "Resident is being molested by another resident while in care": LPA Colvin conducted interviews with residents and facility staff regarding the allegation. LPA Colvin was not provided with any names to aid in investigation of the complaint. LPA Colvin additionally interviewed some family members of resident(s) and no concerns related to the allegation were reported. LPA Colvin additionally reviewed recent Incident Reports for the facility and did not observe any related concerns. Therefore, due to lack of information, the allegation “Resident is being molested by another resident while in care” is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
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 2
Control Number 18-AS-20220725131214
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BUENA VISTA ASSISTED LIVING
FACILITY NUMBER: 331880902
VISIT DATE: 11/29/2022
NARRATIVE
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Regarding allegation "Staff are not meeting the care needs of resident(s) in care": LPA Colvin conducted interviews with residents and facility staff regarding the allegation. LPA Colvin was not provided with any names to aid in investigation of the complaint, though the reporting party did state the concern was with Hospice residents. LPA Colvin additionally interviewed some family members of resident(s) and no concerns related to the allegation were reported. LPA Colvin additionally reviewed recent Incident Reports for the facility and did not observe any related concerns. LPA Colvin reviewed staff notes/charting for residents and observed detailed entries which suggest that residents are being checked on and cared for. LPA Colvin confirmed that there are no untreated issues present for any of the facility’s residents currently on Hospice. Therefore, due to lack of information, the allegation “Staff are not meeting the care needs of resident(s) in care” is UNSUBSTANTIATED.

Regarding allegation "Residents in care are being handled roughly by staff": LPA Colvin conducted interviews with residents and facility staff regarding the allegation. LPA Colvin was not provided with any names to aid in investigation of the complaint. LPA Colvin additionally interviewed some family members of resident(s) and no concerns related to the allegation were reported. LPA Colvin additionally reviewed recent Incident Reports for the facility and did not observe any related concerns. Therefore, due to lack of information, the allegation “Residents in care are being handled roughly by staff” is UNSUBSTANTIATED.

Regarding allegation "Residents are being locked in their rooms while in care": LPA Colvin conducted interviews with residents and facility staff regarding the allegation. LPA Colvin additionally conducted a physical inspection of the resident rooms and confirmed that there are no rooms which are unable to be unlocked from the inside. Therefore, due to lack of evidence, the allegation “Residents are being locked in their rooms while in care” is UNSUBSTANTIATED.

A finding of UNSUBSTANTIATED means 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.

An exit interview was conducted with MedTech Mariel Hernandez and a copy of this report was provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2