336426330-9-12-2023-18-AS-RLAY-CW7NAM-20231001101746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426330
Report Date: 09/12/2023
Date Signed: 09/12/2023 01:54:05 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
09/05/2023 and conducted by Evaluator Chinwe Nwogene

COMPLAINT CONTROL NUMBER: 18-AS-20230905082057

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: 71	DATE:	09/12/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Maria Nevarez, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility has an infestation of cockroaches and mice.

INVESTIGATION FINDINGS:

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On 9/12/2023, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegation. LPA met with Maria Nevarez who was informed of the purpose of the visit. At the time of visit, LPA interviewed staff, and residents, conducted an inspection of the facility and reviewed facility records.
Regrading the allegation “Facility has an infestation of cockroaches and mice”, Staff was interviewed who denied there is cockroaches and mice infestation. Staff stated mice has only been reported one time and cockroaches reported few times. Administrator was interviewed who stated facility is taking preventative measures like placing mice traps outside of the facility and having pest control company visit facility every first and third Wednesday of the month to spray insecticide. LPA conducted inspection of the facility and did not observe any mice or cockroaches however, LPA observed mice traps outside by the entrance of the kitchen. LPA reviewed the pest control reports and log and observed a pest control company visited facility twice in July 2023 and August 2023 for roaches. Pest control report further shows facility is taking measures to keep the facility free from cockroaches and mice and to avoid infestation.
Based on interviews with staff, residents, facility record review and inspection of the facility there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Maria Nevarez.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -24-0313
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

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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