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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602093
Report Date: 04/27/2025
Date Signed: 04/27/2025 10:42:56 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
09/08/2022 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20220908134630
FACILITY NAME:ALTA IIFACILITY NUMBER:
374602093
ADMINISTRATOR:CHRISTINA GRUBBSFACILITY TYPE:
735
ADDRESS:1337 ALTA VISTA DRIVETELEPHONE:
(760) 941-0919
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:6CENSUS: 5DATE:
04/27/2025
UNANNOUNCEDTIME BEGAN:
08:06 AM
MET WITH:Zoe WilsonTIME COMPLETED:
09:22 AM
ALLEGATION(S):
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Licensee failed to supervise resident.
Licensee failed to prevent a resident from exposing themselves to another resident.
INVESTIGATION FINDINGS:
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**On 04/27/2025, the LIC9099 admended to correct the client identifier.On 04/27/2025, at 8:00 am, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit regarding the allegations above. LPA met with the Administrator, as the purpose of the visit was to deliver findings. LPA and the administrator toured the facility inside and outside the grounds.
The investigation consisted of the following:
On 04/26/2025, Licensing Program Analyst (LPA) Antonine Richard initiated a complaint visit regarding the allegation above. On 04/18/2025, between 10:00 am and 11:00 am LPA Richard interviewed the administrator #1 (A1) Zoe Wilson, and obtained copies of the resident roster, staff roster, staff training, and requested the following documents for client #1(C1): emergency ID form, admission agreement, physicians report (dated 2022-2025), needs and services plan (dated 2021-2025), Psychologist assessment (dated 2022-2025). On 04/26/2025, LPA conducted a file review for C1. On 04/26/2025, between 9:00 am and 10:00 am, LPA interviewed four (4) Clients #1-4 (C1-C4). On 04/26/2025, between 11:00 am and 12:00 pm, LPA interviewed three (3) staff members #1-3 (S1-S3). On 04/27/2025, between 8:30 am and 9:00 am, LPA interviewed two (2) staff members (S4-S5) and one (1) client (C5).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 18-AS-20220908134630
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ALTA II
FACILITY NUMBER: 374602093
VISIT DATE: 04/27/2025
NARRATIVE
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Allegation: Licensee failed to supervise the resident.

It is being alleged licensee failed to supervise the resident, resulting in the resident bullying, abusing other residents. On 04/18/2025, between 10:00 am and 11:00 am, LPA interviewed the administrator (A1), who denied the allegation and stated the facility does constantly supervises the client, especially when they are outside in the backyard playing basketball and doing different activities. A1 also stated that the facility always has one (1) or two (2) staff members in the backyard ready to assist the clients. On 04/18/2025 between 1:00 pm and 3:00 pm, LPA interviewed one (1) staff member (S1) who stated that they always have one or two staff members near the clients when outside, ready to assist, redirect, and help the client when agitated. On 04/26/2025 between 9:00 am and 10:00 am, LPA interviewed four (4) clients (C1-C4). 3 out of 4 stated that the staff are with them a lot. On 04/27/2025, between 8:00 am and 8:30 am LPA interview one (1) client (C5) who denied the allegation. On 04/26/2025, between 11:00 am and 12:00 Pm, LPA interviewed two (2) staff (S2-S3); 2 out of 2 denied the allegation, and also stated they are constantly with the client. On 04/27/2025, between 8:30 am and 9:00 am, LPA interviewed two (2) staff members (S4-S5) 2 out of 2 denied the allegation and stated they never witnessed anything like that. 04/26/2025, LPA records reviewed of the LIC 500 indicated that the facility has three staff members on duty per shift, seven days a week. On 04/26/2025, between 9:00 AM and 10:30 am, LPA Richard observed two clients playing outside in the backyard. There were two staff members outside watching and doing activities with them.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20220908134630
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ALTA II
FACILITY NUMBER: 374602093
VISIT DATE: 04/27/2025
NARRATIVE
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Based on LPA observations, interviews, and records reviews, there is not enough evidence to support the allegation mentioned above. 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.

Allegation: Licensee failed to prevent a resident from exposing themselves to another resident.

It is being alleged that the licensee failed to prevent a resident from exposing themselves to another while they were taunting and throwing the basketballs in the backyard. On 04/18/2025, LPA interviewed A1, who stated that the resident has a behavior of emotional outbursts and inappropriate social interactions, but A1 denied ever seeing or being reported to by staff about witnessing a client exposing themselves to other clients while playing in the backyard, or anywhere else. On 04/18/2025, between 1:00 AM and 3:00 PM, LPA interviewed one (1) staff member (S1) who denied the allegation and stated they had never witnessed such behavior among the clients. On 04/26/2025, between 9:00 am and 10:00 am, LPA interviewed four (4) clients (C1-C4). 3 out of 4 say no. On 04/27/2025, between 8:00 am and 8:30 am LPA interview one (1) client (C5) who denied the allegation. On 04/26/2025, between 11:00 am and 12:00 pm, LPA interviewed two (2) staff #2-3 (S2-S3), 2 out of 2 denied the allegation and stated they never witnessed such behavior from the clients living at the facility. On 04/27/2025, between 8:30 am and 9:00 am, LPA interviewed two (2) staff members (S4-S5) 2 out of 2 denied the allegation and stated they never witnessed anything like that.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20220908134630
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ALTA II
FACILITY NUMBER: 374602093
VISIT DATE: 04/27/2025
NARRATIVE
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On 04/26/2025, LPA records review of the client's Behavior intervention plan (dated 01/01/22, 01/01/23, and 01/21/25) does not indicate that the client exhibits this type of behavior. On 04/26/2025, LPA observed the clients playing, doing activities, and there was no display of any inappropriate social interactions between the residents.

Based on LPA observations, interviews, and records reviews, there is not enough evidence to support the allegation mentioned above. 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.

No deficiencies were cited. Exit interview conducted. A copy of the report was provided to the Administrator Zoe Wilson.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4