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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426330
Report Date: 12/12/2025
Date Signed: 12/12/2025 11:16:39 AM

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
04/05/2024 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20240405113514
FACILITY NAME:VISTA MONTANA SENIOR LIVINGFACILITY NUMBER:
336426330
ADMINISTRATOR:MARYANN KANEKOAFACILITY TYPE:
740
ADDRESS:155 N. GIRARD ST.TELEPHONE:
(951) 658-2274
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:120CENSUS: 84DATE:
12/12/2025
UNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Maria ForkrudTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff did not ensure that resident was adequately fed.
Staff does not treat resident with dignity or respect.
Staff does not ensure residen's needs are met.
INVESTIGATION FINDINGS:
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On December 11, 2025, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent visit to deliver findings regarding the above allegations. LPA Richard met with the Administrator Maria Forkrud (A1), and the purpose of the complaint was explained. LPA and the Administrator toured the facility.

The investigation consisted of the following: On April 09, 2024, Licensing Program Analyst (LPA) Yolanda Delgado conducted an unannounced visit to the facility to initiate an investigation into the allegations listed above. LPA met with Administrator Mary Ann Nevarez and explained the purpose of the visit. LPA Delgado interviewed two (2) staff members and one (1) resident and requested and obtained copies of pertinent documentation. On December 11, 2025, Licensing Program Analyst (LPA) Richard reviewed and received the following documents. Resident roster (dated 12/10/25), the Staff Roster (dated 12/02/25), and the admission agreements (dated 08/25/20). Physician report (dated 03/18/24) for (R1). Facility menu dated June 2023. LPA, Richard, also conducted interviews with six residents (R1-R6) and five staff members (S1-S5), and the administrator (A1).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2025
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 4
Control Number 18-AS-20240405113514
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: 12/12/2025
NARRATIVE
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Allegation #1: Staff did not ensure that the resident was adequately fed.

The complaint alleged that when bringing food to resident R1, R1 ate so quickly that R1 claimed not to have been eating. On December 11, 2025, the LPA interviewed the Administrator (A1), who denied the allegation and stated the facility offers three meals a day along with snacks between meals. On the same day, the LPA interviewed five staff members #1-5 (S1-S5), who also denied the allegation and affirmed that the facility provides all residents with adequate portions of food and offers an optional menu if they do not want what is served. They also provide snacks three times daily. Additionally, on December 11, 2025, the LPA interviewed six residents #1-6 (R1-R6), five of whom denied being inadequately fed by the facility. Three out of five residents mentioned that the facility gave them a second plate when asked. The same day, the LPA reviewed the facility’s menu, which showed a variety of foods and an optional menu. The LPA observed residents eating lunch and noted that the portions served were substantial. On December 11, 2025, the LPA attempted to interview R1; however, R1 was unable to answer the questions due to cognitive impairment.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur; therefore, the allegation is Unsubstantiated.

Report continued on LIC9099C.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20240405113514
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: 12/12/2025
NARRATIVE
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Allegation #2: Staff do not treat the residents with dignity and respect.

The complaint alleged that the facility staff are mean to R1, who felt scared. On December 11, 2025, the LPA interviewed the Administrator (A1), who denied the allegation and stated that R1 never mentioned that the staff is mean to R1. On the same day, the LPA interviewed five staff members #1-5 (S1-S5), who also denied the allegation and confirmed that no residents ever complained to them about other staff being mean to them. Additionally, on December 11, 2025, the LPA interviewed six residents, #1-6 (R1-R6), five of whom denied that staff were mean to them. On December 11, 2025, the LPA attempted to interview R1; however, R1 was unable to answer the questions due to cognitive impairment.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur; therefore, the allegation is Unsubstantiated.

Allegation #3: Staff do not ensure residents’ needs are met.

The complaint concerned resident 1 (R1)'s overall well-being and whether R1's needs are being met. On December 11, 2025, LPA Richard interviewed the Administrator (A1), who denied that the residents' well-being was being neglected.

Report continued on LIC9099C.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20240405113514
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: 12/12/2025
NARRATIVE
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On the same day, LPA interviewed five staff members, #1-5 (S1-S5), all of whom denied the allegation and stated that the residents are well cared for daily. The caregiver checked on the residents every 2 hours. If a resident pressed the pendant for help, a staff member would go to assist them. Additionally, on December 11, 2025, LPA interviewed six residents, #1-6 (R1-R6). Five of the six denied the allegation, stating that staff helped them and that their needs are being met. LPA attempted to interview R1; however, R1 was unable to answer the questions due to cognitive impairment. On December 11, 2025, LPA observed staff interact with residents with care and respect. Residents were showing pictures on the wall and smiling.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur; therefore, the allegation is Unsubstantiated.

No Deficiencies cited.

An Exit interview was conducted. A copy of this report was provided to the Administrator Maria Forkrud.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4