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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881258
Report Date: 10/28/2022
Date Signed: 10/28/2022 02:39:38 PM

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
06/29/2022 and conducted by Evaluator Chinwe Nwogene
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220629084542
FACILITY NAME:VINEYARD RANCH AT TEMECULAFACILITY NUMBER:
331881258
ADMINISTRATOR:KNAUER, KURTFACILITY TYPE:
740
ADDRESS:27350 NICOLAS ROADTELEPHONE:
(951) 308-1988
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY:98CENSUS: 88DATE:
10/28/2022
UNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Kurt Knauer, Executive Director
Kelley Lara, Business Office Manager		TIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Facility staff member was physically abusive toward a resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Chinwe Nwogene made an unannounced visit to the facility to conclude a complaint investigation into the allegation listed above. LPA met with Executive Director, Kurt Knauer and Business Office Manager, Kelley Lara and discussed the purpose of the visit. During the investigation, LPA conducted interviews with Residents and Staff, and reviewed staff files.
Regarding the allegation “Facility staff member was physically abusive toward a resident”. LPA interviewed residents who revealed a PM caregiver is rough when providing care. A resident stated the PM caregiver forcefully pulled him by the arm, scratched him in the process and caused him a skin tear. LPA interviewed the PM staff who denied being rough or physically abusive towards residents. LPA interviewed the Executive Director (ED), Kurt Knauer who acknowledged to have received reports regarding the identified PM caregiver being rough when providing care. LPA reviewed staff files and discovered the identified PM caregiver has been reprimanded numerous times for being rough when providing care to residents.
Based on interviews conducted and file review, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division & Chapter number 6) are being cited on the attached LIC9099D). An exit interview was conducted, and a copy of this report was reviewed and provided along with appeal rights Kelley Lara.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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-20220629084542
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: VINEYARD RANCH AT TEMECULA
FACILITY NUMBER: 331881258
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2022
Section Cited
CCR
87468.1(a)(3)
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Personal Rights of Residents in All Facilities;
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature....
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Executive Director stated staff will take a Personal Rights of residents training and provide proof of the training to LPA by the POC due date 11/7/2022
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Based on interview and file review the licensee did not comply with the section cited above by allowing the PM caregiver to continuously being rough when providing care to residents which poses an immediate health, safety or personal rights risk to persons 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: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2