336426330-8-18-2021-18-AS-EMAN-CCYPZ6-20220329114502

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426330
Report Date: 08/18/2021
Date Signed: 08/18/2021 01:37:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/12/2021 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210812155557

FACILITY NAME:	VISTA MONTANA SENIOR LIVING		FACILITY NUMBER:	336426330
ADMINISTRATOR:	MARILOU CARLSON		FACILITY TYPE:	740
ADDRESS:	155 N. GIRARD ST.		TELEPHONE:	(951) 658-2274
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	120	CENSUS: 63	DATE:	08/18/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Raquel Montes		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Residents sustained injuries while in care
Residents were left in soiled diapers for an extended period of time
Facility staff did not manage resident's medications correctly
Resident rooms are unkempt due to lack of staff
Staff are not appropriately assisting residents with their showers

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Williams made an unannounced visit to the facility in order to initiate an investigation into the above allegations. LPA met with Administrator, Raquel Montes, and discussed the purpose of the visit. The investigation consisted of records review, direct observation, and interviews with staff and residents.

In regards to allegation #1, LPA interviewed Resident #1 (R1), Resident #2 (R2), and Resident #3 (R3) who denied sustaining any injuries nor did they experience/witness physical abuse by the facility staff. LPA also interviewed Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), and Staff #4 (S4) who all denied observing/causing any injuries to the residents. LPA could not find evidence to corroborate the allegation; therefore, the allegation is unsubstantiated.

In regards to allegation #2, LPA interviewed R1, R2, and R3 who denied being left in soiled diapers for an extended period of time. LPA interviewed S1, S2, S3, and S4 who denied that residents are being left in

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021

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-20210812155557

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VISTA MONTANA SENIOR LIVING	FACILITY NUMBER: 336426330
	VISIT DATE: 08/18/2021

NARRATIVE

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soiled diapers for an extended period of time. S1, S2, S3, and, S4 stated that facility staff follow protocol, which is to check residents for incontinence every 2 hours, or more for those who need more incontinence care. S4 stated that facility staff cannot determine how long a resident has been left with a soiled diaper during shift changes. LPA could not find evidence to corroborate the allegation; therefore, the allegation is unsubstantiated.

In regards to allegation #3, LPA interviewed S1 who stated that one resident's narcotic medication went missing; however, the facility was not managing those medications as the resident's physician noted on the Physician's Report that the resident was able to manage own medications at the time. LPA interviewed S2 and S4 who denied that residents medications are managed incorrectly. LPA interviewed R1, R2, and R3 who all stated that they are getting all of their medications on time. LPA could not find evidence to corroborate the allegation; therefore, the allegation is unsubstantiated.

In regards to allegation #4, LPA inspected four resident bedrooms and observed them to be orderly and maintained. LPA interviewed R1, R2, and R3 who stated that housekeeping cleans their rooms once a week. LPA interviewed S1 and S4 who stated that housekeeping staff clean rooms weekly and upon request. LPA could not find evidence to corroborate the allegation; therefore, the allegation is unsubstantiated.

In regards to allegation #5, LPA interviewed S1 who stated that the facility has a dedicated staff member who solely provides showering for residents. S1 also stated that staff members on each shift provide showers for the residents. LPA interviewed R3 who stated that the facility has been providing showers three times a week. LPA interviewed S2, S3, and S4 who stated that facility staff are providing each resident with a shower three times a week. LPA could not find evidence to corroborate the allegation; therefore, the allegation is unsubstantiated.

Based on evidence obtained during today’s visit, LPA has determined that the above allegations are UNSUBSTANTIATED; meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed and a copy was provided to the Administrator.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021

LIC9099 (FAS) - (06/04)

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