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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881258
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:46:48 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
07/20/2022 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20220720104831
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: 89DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Kurt Knauer, Executive DirectorTIME COMPLETED:
02:55 PM
ALLEGATION(S):
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Resident sustained multiple injuries while in care.
Resident is not receiving assistance when using the restroom.
INVESTIGATION FINDINGS:
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On November 16, 2022, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation into the allegation listed above. LPA met with Executive Director, Kurt Knauer and explained the purpose of the visit. During the investigation LPA interviewed Confidential witness, interviewed staff, and reviewed resident file.
Regarding the allegation “Resident sustained multiple injuries while in care”. LPA interviewed staff who stated resident #1 (R1) sustained multiple injuries due to fall, however, the fall happened because R1 wouldn’t press R1 pendant to call for help. LPA interviewed Confidential Witness who confirmed while at the hospital, R1 admitted to not pressing the pendant which led to R1 falling and sustaining multiple injuries.

Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
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-20220720104831
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
VISIT DATE: 11/16/2022
NARRATIVE
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Continued from LIC9099

Regarding the allegation “Resident is not receiving assistance when using the restroom”. It was alleged that R1 did not receive assistance when using the restroom. LPA interviewed staff who stated R1 likes to be independent and doesn’t ask for help when using bathroom. LPA interviewed Confidential witness who confirmed R1 like to be independent and while at the hospital R1 admitted to not pressing the pendant when going to the bathroom. R1 file review revealed R1 is able to care for own bathroom needs.
Based on interviews with staff, confidential witness and a review of resident records, there is not enough evidence to support allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Kurt Knauer.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2