336426083-3-13-2025-18-AS-RSTS-DF7TUB-20250328150202

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426083
Report Date: 03/13/2025
Date Signed: 03/13/2025 04:04:31 PM

Unfounded

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
03/05/2025 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20250305081005

FACILITY NAME:	ATRIA PARK OF VINTAGE HILLS		FACILITY NUMBER:	336426083
ADMINISTRATOR:	MARIANO Q. HERNANDEZ		FACILITY TYPE:	740
ADDRESS:	41780 BUTTERFIELD STAGE RD		TELEPHONE:	(951) 506-5555
CITY:	TEMECULA	STATE: CA	ZIP CODE:	92592
CAPACITY:	143	CENSUS: 119	DATE:	03/13/2025
		UNANNOUNCED	TIME BEGAN:	08:44 AM
MET WITH:	Mariano Hernandez, Executive Director		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff are not addressing a change in resident's condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation listed above. LPA met with Mariano Hernandez, Executive Director and explained the purpose of the visit and the elements of the allegation. The allegation was investigated, and the investigation consisted of observations interviews and records review.

On 03/05/25 Community Care Licensing received a complaint alleging that staff are not addressing a change in resident's condition. It was alleged that resident Resident #1 (R1) had change in condition due to allegedly having pain, challenges with toileting, and vomiting. LPA conducted a review of R1s resident notes that revealed R1 to have been sent out of the community on 01/19/25, and 02/17/25, due to having chest pain. LPA conducted interviews with Executive Director Mariano Hernandez which revealed that R1 has not had a change of condition, and that unless something happens R1 is not due for another assessment until October 2025. Administrator Hernandez shared that the facility has a Nurse Practitioner that makes on site visits on Mondays and as of today, on Thursdays. LPA conducted a records review of R1s

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 217-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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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Control Number 18-AS-20250305081005

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: 03/13/2025

NARRATIVE

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Resident notes, and there is nothing noted regarding the symptoms noted that are related to the alleged change of condition, there was some preexisting conditions. In addition LPA conducted a review of R1s prescriptions and Medication Authorization Record for February and March 2025 that revealed R1 was prescribed medications associated with other medically related diagnoses.

LPA conducted an interview with R1 whom denied the allegation, as they stated they were great and they have not recently experienced what was reported. R1 stated that they receive care when they need it, and stated that they do not have a problem as they let their needs be known to the staff. Based on observation, interviews and records review the allegation of staff are not addressing a change in resident's condition is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report, LIC811-Confidential names list was reviewed and provided to Mariano Hernandez, Executive Director.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 217-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC9099 (FAS) - (06/04)

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