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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426083
Report Date: 12/17/2025
Date Signed: 12/17/2025 11:41:23 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
06/14/2022 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220614104432
FACILITY NAME:ATRIA PARK OF VINTAGE HILLSFACILITY NUMBER:
336426083
ADMINISTRATOR:MARIANO Q. HERNANDEZFACILITY TYPE:
740
ADDRESS:41780 BUTTERFIELD STAGE RDTELEPHONE:
(951) 506-5555
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:143CENSUS: 173DATE:
12/17/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Crissy Panganiban Engage Life DirectorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility failed to check on the safety of resident
INVESTIGATION FINDINGS:
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**This report supersedes report dated 10/25/2025. The reason the report is being superseded is to correct the previous citation issued on 10/25/2025 from 87468.1(a)(2) to 87468.2(a)(4), all other findings remain the same.** Licensing Program Analyst (LPA) Christian Gutierrez faxed over a copy of of this corrected LIC 9099. Executive Director Quinn Hernandez was notified by telephone.


SEE LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
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 3
Control Number 18-AS-20220614104432
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ATRIA PARK OF VINTAGE HILLS
FACILITY NUMBER: 336426083
VISIT DATE: 12/17/2025
NARRATIVE
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The investigation consisted of the following: During the initial visit conducted on 06/17/2022, LPA Chinwe Nwogene toured the facility, interviewed staff 1-staff 4 (S1-S4), reviewed resident files, and collected pertinent documents. On 10/25/2025 LPA Gutierrez interviewed Executive Director by telephone, S5 by telephone, attempted phone interview with S6 and S7 in person, and residents 2- residents 10 (R2-R10). LPA obtained copies of the following documents: staff roster, resident roster, R1’s physicians reports, monthly responsibility personal care rate document, functional needs/service plan, identification information (LIC 601), and face sheet. During today’s visit LPA delivered findings.

In regard to the allegation” Facility failed to check on the safety of resident”, It is alleged that after three days of calling R1 with no answer family went to facility and found R1 on floor and had to tell staff for help. During interview with Executive Director, staff three (3) out of seven (7) stated that R1 required no level of care and was independent. Executive director stated that meal checks are the only way to check on residents for the day and that the meal checks have not being done properly in the past. S3 stated that R1 was marked as refused on 06/09/2002 and 06/10/2022 because he/she did not see R1 at mealtime and assumed R1 did not want to eat. S4 stated they were responsible for verifying and signing off the meal attendance report but had not been doing that. During interviews with residents nine (9) out of ten (10) stated that staff comes and checks on them. R2 stated it may take them awhile, but they come eventually. Despite more than one staff knowing that R1 missed meals for 2 days there is no evidence that staff went to check on R1.

Based on record review and conducted interviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of this report was given to Crissy Pan

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20220614104432
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ATRIA PARK OF VINTAGE HILLS
FACILITY NUMBER: 336426083
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/08/2025
Section Cited
CCR
87468.2(a)(4)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities
(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:
(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.

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Director will conduct in service training with staff on section 87468.2 (a)(4) and the meal attendace policy and send LPA signed staff sheet by POC due date.
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This deficiency is evidenced by the following:'
R1 had not been seen for meals for three days and staff did not follow the policy of meal attendace and go check on resident resulting in R1 being found on the ground 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.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3