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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880835
Report Date: 07/27/2023
Date Signed: 07/27/2023 02:30:41 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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/03/2023 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20230503092034
FACILITY NAME:VISTA BLUE MOUNTAINFACILITY NUMBER:
361880835
ADMINISTRATOR:ASHLEY WILLETTFACILITY TYPE:
740
ADDRESS:22325 BARTON ROADTELEPHONE:
(909) 420-0153
CITY:GRAND TERRACESTATE: CAZIP CODE:
92313
CAPACITY:0CENSUS: 0DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ashley Willett-AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff did not provide resident with medical records
Staff are not providng residents with moving assistance
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/27/2023 at 2:00 PM, Licensing Program Analyst (LPA) Bernadette Allen met with Administrator Ashley Willett at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to deliver the findings for the mentioned allegations.

Staff did not provide resident with medical records- The interview with the R’1’s responsible party and staff member said that the R1 can keep their own medical document and the facility did not have to retain documents on file.
Staff are not providing residents with moving assistance- Interviews were conducted (11) Eleven outside parties who said that residents were provided with a 60-day written notice informing them of the facility closure and that they were provided with resources for relocating residents.

Based on the interviews and document reviewed the above allegations are Unsubstantiated. A finding of unsubstantiated means 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.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
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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