336426330-9-26-2022-18-AS-JESL-CK7U66-20221014151749

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426330
Report Date: 09/26/2022
Date Signed: 09/26/2022 10:17:07 AM

Unfounded

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
09/19/2022 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220919091025

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: 64	DATE:	09/26/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Raquel Montes - General Manager		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff do not ensure a safe and healthful environment by preventing residents from harassing a resident
Staff does not accord dignity in their relationship with a resident in care
Residents sustained injury while in care
Staff withheld meals from resident in care
Staff restricted resident's activity

INVESTIGATION FINDINGS:

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Licensing Program Analsy (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of initating and investigation for the above allegations. LPA Colvin met with General Manager Raquel Montes and informed her of the prupose of today's inspection. Below is a summary of the findings:

Regarding allegation "Staff do not ensure a safe and healthful environment by preventing residents from harassing a resident": LPA Colvin requested a resident roster for both Assisted Living and Independent Living, though only the Assisted Living building is included in the facility's license. LPA Colvin observed that the resident of concern (R1) in the allegation is a tenant in the Independent Living building, for which Community Care Licensing (CCL) has no jurisdiction. LPA Colvin additionally confirmed that the other residents in the allegation (R2, R3, & R4) also reside in the Indepdent Living building. LPA Colvin further verified this by obtaining a copies of relevant residents' lease. Since this allegation is in regards to the non-licensed portion of the grounds, and CCL does not have the authority to impose Title 22 Regulations on non-licensed buildings, the allegation "Staff do not ensure a safe and healthful environment by preventing residents from harassing a resident" is UNFOUNDED.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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-20220919091025

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: 09/26/2022

NARRATIVE

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Regarding allegation "Staff does not accord dignity in their relationship with a resident in care": This allegation again, was in regards to R1, who does not live in the licensed portion of the facility. Therefore, CCL does not have authority over issues in the Independent Living building, and the allegation "Staff does not accord dignity in their relationship with a resident in care" is UNFOUNDED.

Regarding allegation "Residents sustained injury while in care": LPA Colvin interviewed General Manager Raquel Montes and inquired about which resident (two residents with same name, one in each building) sustained an injury recently. Raquel Montes stated that it was R2 and provided additional details regarding the nature of the injury, which matches the information provided in the allegation. There was an additional resident noted to have been injured from a bite caused by a resident's dog, but this resident (R4) LPA Colvin additionally identified as being a resident in Independent Living, as observed through the Resident Rosters for both buildings. Since R2 & R4 are residents in the Independent Living building, which is not licensed by CCL. Therefore, the allegation "Residents sustained injury while in care" is UNFOUNDED.

Regarding allegation "Staff withheld meals from resident in care": This allegation again, was in regards to R1, who does not live in the licensed portion of the facility. Therefore, CCL does not have authority over issues in the Independent Living building, and the allegation "Staff withheld meals from resident in care" is UNFOUNDED.

Regarding allegation "Staff restricted resident's activity": This allegation again, was in regards to R1, who does not live in the licensed portion of the facility. Therefore, CCL does not have authority over issues in the Independent Living building, and the allegation "Staff restricted resident's activity" is UNFOUNDED.

The Deaprtment conducted an investigation of the above allegations, which were determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without reasonable basis. We have therefore dismissed the complaint.

An exit interview conducted and a copy of this report provided to General Manager Raquel Montes.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC9099 (FAS) - (06/04)

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