331881008-10-28-2023-18-AS-KCLS-CX52E9-20231030171934

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881008
Report Date: 10/28/2023
Date Signed: 10/28/2023 11:39:08 AM

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
08/12/2021 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 18-AS-20210812112757

FACILITY NAME:	WINE COUNTRY ASSISTED LIVING		FACILITY NUMBER:	331881008
ADMINISTRATOR:	SCHNEIDER, ELVIRA		FACILITY TYPE:	740
ADDRESS:	5 SHASTA LAKE DR		TELEPHONE:	(818) 277-0403
CITY:	RANCHO MIRAGE	STATE: CA	ZIP CODE:	92270
CAPACITY:	0	CENSUS: 0	DATE:	10/28/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Janet Munoz-Support Staff		TIME COMPLETED:	11:42 AM

ALLEGATION(S):

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Staff failed to treat residents with respect
Staff failed to meet the residents' needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to deliver findings for the mentioned allegations. LPA Allen met with Janet Munoz who was informed of the purpose of the visit.

LPA Allen conducted interviews with residents, resident’s responsible parties and staff members.
The interviews conducted with six (6) staff members, two (2) residents, and four (4) responsible parties have all stated staff members treat the residents with respect and staff members meets their needs daily. Residents have also stated they enjoy being at the facility.

Based on the interviews conducted with staff, residents, and responsible parties the above allegations are Unsubstantiated. A finding of unsubstantiated means although the allegations 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 Janet Munoz-Support Staff and a copy was provided and appeal rights at the conclusion of the visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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