336426330-7-2-2026-18-AS-PMAA-DVZLG9-20260715084422

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426330
Report Date: 07/02/2026
Date Signed: 07/02/2026 03:02:02 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
11/07/2024 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20241107143439

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: 85	DATE:	07/02/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	MARIA FORKRUD		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff are not meeting resident's dietary needs.
Facility staff member is mishandling resident's funds.

INVESTIGATION FINDINGS:

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On July 02, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint visit. LPA met with the Administrator (A1), Maria Forkrud, and explained the purpose of the visit.

The complaint investigation consisted of the following. On July 2, 2026, the Department obtained various documents, including the Personnel Report LIC 500 (dated 07/01/26) and the Resident Roster (dated 06/19/26). The Department reviewed and collected documents for Resident 1 (R1), including the Admission Agreement dated 06/20/2024, the physician's Report dated 06/14/2024, and the facility history Ledger payment dated 12/13/2024. The Department interviewed the Administrator (A1), five staff members (S1-S5), and nine residents (R2-R10). On July 2, 2026, the Department was unable to interview Resident 1 (R1) because the resident moved out of the facility on 12/13/2024. The Department later confirmed through the Assisted Living Worker (ALW) that Resident 1 moved out of the facility on December 13, 2024.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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-20241107143439

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: 07/02/2026

NARRATIVE

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Allegation #1: Facility staff are not meeting resident’s dietary needs.

The complaint alleged that the facility failed to provide residents with food. On July 2, 2026, the department interviewed the Administrator (A1), who denied the allegation. A1 stated that the facility has a weekly menu, an alternating menu, and a diabetic menu. Meals are served at the following times: breakfast at 7:00 a.m., lunch at 11:00 a.m., dinner at 4:00 p.m., and snacks are available between lunch and dinner. A snack cart is also accessible in the medication room at 6:00 p.m. upon request.

On the same date, the department interviewed five staff members (S1-S5), all of whom denied the allegation. They confirmed that for all residents with doctor’s orders, as well as those with diabetes or allergies, the medication technician ensures that the kitchen is informed and that relevant information is posted on the whiteboard for kitchen staff and caregivers.

Additionally, the department interviewed nine residents (R2-R10), all of whom denied the allegation, stating that they enjoy the food served at the facility and that the portion sizes are adequate. On November 15, 2024, the department also interviewed resident R1, who denied that the facility fails to provide meals, stating that R1 has three meals a day and does not require a modified diet. The department later confirmed through the Assisted Living Worker (ALW) that resident R1 moved out of the facility on December 13, 2024.

Report Continued on LIC9099C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 18-AS-20241107143439

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: 07/02/2026

NARRATIVE

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During the facility tour on July 2, 2026, the department observed a food menu available to residents that included well-balanced, nutritious meal options. They also noted that the facility maintained an adequate supply of food, including fruits and vegetables. A review of resident R1's physician's report showed no dietary restrictions or special orders.

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.

Allegation #2: Facility staff member is mishandling resident's funds.

The complaint alleged that the facility is not providing resident R1 with their finances. On July 2, 2026, the department interviewed the Administrator (A1), who denied the allegation, stating that the facility does not manage R1's finances. The Assisted Living Waiver (ALW) deposits a portion of the rent into the facility's account, and R1 pays the remaining portion directly to the facility. A1 also mentioned that since R1 moved to the facility on June 20, 2024, the facility has never managed R1's personal and incidental (P&I) funds.

On the same day, the department interviewed five staff members (S1-S5), all of whom stated they did not know about the resident's finances. Additionally, the department spoke to nine residents (R2-R10); three of them claimed that the facility manages their finances and that they have never experienced any issues with their money. The other six residents reported that they manage their own finances.

Report continued on LIC9099C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 18-AS-20241107143439

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: 07/02/2026

NARRATIVE

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On November 15, 2024, the department interviewed R1, who denied the allegation, explaining that they handle their own finances. R1 receives income from Social Security and Disability, which covers their rent, and they also manage their own cash. The department further interviewed the ALW on July 2, 2026, who confirmed that they deposit only their portion of the rent into the facility and that R1 pays the remaining balance.

Finally, on July 2, 2026, the department reviewed R1's Tenant Ledger records, which indicated that R1 paid the remaining portion of the rent to the facility by check and in cash until R1 moved out on December 13, 2024.

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.

No deficiencies were cited.

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

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4