361880835-8-31-2022-56-AS-NBRN-CKBVZ4-20221018165206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880835
Report Date: 08/31/2022
Date Signed: 08/31/2022 03:12:53 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
08/26/2022 and conducted by Evaluator Rohit Lama

COMPLAINT CONTROL NUMBER: 56-AS-20220826140014

FACILITY NAME:	VISTA BLUE MOUNTAIN		FACILITY NUMBER:	361880835
ADMINISTRATOR:	PENDING		FACILITY TYPE:	740
ADDRESS:	22325 BARTON ROAD		TELEPHONE:	(909) 420-0153
CITY:	GRAND TERRACE	STATE: CA	ZIP CODE:	92313
CAPACITY:	150	CENSUS: 68	DATE:	08/31/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Ashley Willett, Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Administrator was not safeguarding a Resident's Medical Information

INVESTIGATION FINDINGS:

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At 12:30 PM on 08/31/2022, Licensing Program Analyst (LPA) Rohit Lama conducted an unannounced visit to initiate a complaint investigation and deliver the findings for the allegations listed above. LPA met with Ashley Willett, Executive Director.

Interviews were conducted with: Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), Resident #5 (R5), Resident #6 (R6), Staff #1 (S1), and Staff #2 (S2).

The allegation above states that Medical Information for a resident was not being safeguarded by the Facility Staff. Specifically, that Medical Information is discussed in the presence of other individuals, such as other Residents. LPA Interviewed six residents. Six out of six residents stated that this is not the case. All six residents stated that they have never overheard any Staff Member openly discussing any Resident's Personal Information. ***CONTINUED ON LIC 9099-C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Rohit Lama	TELEPHONE: 951-217-9826
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

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 56-AS-20220826140014

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
, CA 92507

FACILITY NAME: VISTA BLUE MOUNTAIN	FACILITY NUMBER: 361880835
	VISIT DATE: 08/31/2022

NARRATIVE

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***CONTINUED FROM LIC 9099***

LPA also interviewed two Staff Members. Two out of two Staff Members also stated that this allegation is not true. Both S1 and S2 stated that all staff members are careful when discussing sensitive information.

Based on the evidence gathered during the investigation, the above allegation is found to be Unsubstantiated. 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.
LPA conducted an exit interview where this report was discussed with the Licensee. A copy of this report was provided to the Executive Director at the conclusion of this investigation.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Rohit Lama	TELEPHONE: 951-217-9826
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

LIC9099 (FAS) - (06/04)

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