336426330-12-15-2023-18-AS-RSTS-CYRPD6-20231222101258

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426330
Report Date: 11/13/2023
Date Signed: 12/15/2023 01:05:59 PM

Unsubstantiated

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
09/27/2023 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20230927151818

FACILITY NAME:	VISTA MONTANA SENIOR LIVING		FACILITY NUMBER:	336426330
ADMINISTRATOR:	MARYANN KANEKOA		FACILITY TYPE:	740
ADDRESS:	155 N. GIRARD ST.		TELEPHONE:	(951) 658-2274
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	120	CENSUS: 74	DATE:	11/13/2023
		UNANNOUNCED	TIME BEGAN:	09:36 AM
MET WITH:	Executive Director - Maria Nevarez		TIME COMPLETED:	11:39 AM

ALLEGATION(S):

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Staff member sexually assaulted resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to conclude and deliver findings to an investigation regarding the above allegation. LPA was granted entry and met with Executive Director Maria Nevarez who was informed of the purpose of the visit.

Regarding the allegation “Staff member sexually assaulted resident”, LPA conducted interviews and record review in relation to Resident One (R1). R1 stated Staff One (S1) had sexually assaulted R1 by performing inappropriate actions during a bathing and diaper change routine. Based on interviews conducted with staff and R1, during the bathing and diaper change, S1 had inappropriately flicked R1 on their breast and had made R1 uncomfortable during a diaper change. During the diaper change, S1 had their head uncomfortably close to R1’s lower body area while changing them. R1 had informed other staff members regarding the incident and Staff Two (S2) had reported it to management. LPA’s interview with Resident Care Director, Nikki Carter (NC), revealed that S1 stated they were picking at a pimple that was on R1’s breast. NC informed S1 to “not go near R1 after this incident”. (CONTINUED LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

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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Control Number 18-AS-20230927151818

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: VISTA MONTANA SENIOR LIVING	FACILITY NUMBER: 336426330
	VISIT DATE: 11/13/2023

NARRATIVE

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LPA asked if S1 had been assigned to bathe R1 prior to this incident and NC stated yes S1 was assigned to bathe and conduct diaper changes for R1 with no prior incidents. Based on LPA’s interviews and record review there were no previous incidents regarding S1 and other residents.

S1 was sent home on 08/28/2023 due to pending test results for a drug test. S1 does not have a valid phone number on file and the facility has not been able to reach S1. LPA contacted S1’s previous employer at a different facility requesting S1’s contact information. S1’s contact information from the previous employer was not in service and S1 is currently homeless. LPA asked if S1 was currently working at the facility and Executive Director Nevarez stated S1 had quit and is no longer working at the facility. Due to the lack of contact information for S1, LPA was not able to conduct an interview with S1. Staff and resident interviews provided no information that could corroborate or refute the validity of the allegation. Therefore based on interviews and record review this allegation is deemed UNSUBSTANTIATED at this time.

A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was reviewed with and provided to Executive Director Maria Nevarez.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

LIC9099 (FAS) - (06/04)

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