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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881008
Report Date: 03/22/2022
Date Signed: 01/26/2023 10:01:25 AM

Substantiated


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
03/17/2022 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220317152020
FACILITY NAME:WINE COUNTRY ASSISTED LIVINGFACILITY NUMBER:
331881008
ADMINISTRATOR:SCHNEIDER, ELVIRAFACILITY TYPE:
740
ADDRESS:5 SHASTA LAKE DRTELEPHONE:
(818) 277-0403
CITY:RANCHO MIRAGESTATE: CAZIP CODE:
92270
CAPACITY:6CENSUS: 6DATE:
03/22/2022
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Elvira Schneider, LicenseeTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Facility is not providing residents with ample opportunity for family visits.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to investigate the above allegation. LPA met with Licensee Elvira Schneider and explained the purpose of the visit. During the visit LPA inspected the facility, reviewed facility documentation and conducted interviews with staff. It was alleged that facility is not providing residents with ample opportunity for family visits. During an interview with the Licensee, it was confirmed that visits were being limited to Tuesday, Wednesday, Friday, Saturday and Sunday between 12:45pm to 4:45pm. No visitors were allowed on Mondays and Thursdays. LPA also obtained a copy of an email sent by the Licensee which also documents the restricted hours. Based upon this information, the allegation is SUBSTANTIATED and a citation was issued. An exit interview was conducted with Ms. Schneider. A copy of this report, along with Appeal Rights, were discussed with and provided to Ms. Schneider.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
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-20220317152020
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: WINE COUNTRY ASSISTED LIVING
FACILITY NUMBER: 331881008
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2022
Section Cited
CCR
87465(b)(7)
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PERSONAL RIGHTS OF RESIDENTS IN ALL FACILITIES: (b) All..A licensee..may not..(7) Restrict a resident’s right to associate..This requirement is not met as evidenced by:
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Licensee agrees to review regulation, and self-certify that it is understood, by submitting an email to LPA by POC date. Licensee corrected visiting hours at time of visit. POC cleared.
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Based on documentation reviewed by LPA, Licensee did not adhere to the regulation by only allowing visits Tuesday's & Wednesday's and Friday through Sunday between 12:45pm-4:45pm.This poses a potential health and safety and personal rights risk to residents in care.
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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.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2