336426330-11-17-2022-18-AS-DMUN-CLNSQL-20221130130455

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426330
Report Date: 11/17/2022
Date Signed: 11/17/2022 01:19:41 PM

Unsubstantiated

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
01/07/2022 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220107082159

FACILITY NAME:	VISTA MONTANA SENIOR LIVING		FACILITY NUMBER:	336426330
ADMINISTRATOR:	RAQUEL MONTES		FACILITY TYPE:	740
ADDRESS:	155 N. GIRARD ST.		TELEPHONE:	(951) 658-2274
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	120	CENSUS: 66	DATE:	11/17/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Maryann Nevarez, Administrator		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Lack of supervision resulted in resident being sexually abused by another resident
Lack of supervision resulted in resident being assaulted by another resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to conclude a complaint investigation into the allegations listed above. LPA met with Administrator (AD) Maryann Nevarez and discussed the purpose of the visit.
Regarding the allegation "Lack of supervision resulted in resident being sexually abused by another resident”, it was alleged that facility staff failed to provide adequate supervision of residents which allowed Resident #1 (R1) to sexually abuse Resident #2 (R2). The investigation revealed R1 and R2 were found to be in a sitting position on R1’s bed. Although R1 and R2 were observed to have their pants down and/or off, R1 was still clothed in underwear and R2 was still wearing an adult brief and both were wearing upper garments. There was no evidence that R2’s adult brief had been tampered with in a manner consistent with its removal or destruction. Additionally, R2 had been observed in the hallway by staff no more than fifteen (15) minutes prior to being found in R1’s room. While R1 had returned to their room from being outside to smoke within one half hour of the incident.
Regarding the allegation “Lack of supervision resulted in resident being assaulted by another resident”, it
(CONTINUED ON LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

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-20220107082159

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: 11/17/2022

NARRATIVE

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(CONTINUED FROM LIC9099)
was alleged that facility staff failed to provide adequate supervision of residents which allowed R1 to assault Resident #3 (R3). The investigation revealed R1 and R3 were roommates and R1 was angry with R3 over the condition of their shared bathroom, however this issue had not been communicated to staff. While on a smoke break, R1 pushed R3 over while R3 sat in a chair. There had been no previous incidents between the two roommates, and residents had utilized the smoking area together on previous occasions without incident.
Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
An exit interview was conducted, and a copy of this report was provided along with LIC811 – Confidential Names List.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

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