374602093-4-27-2025-18-AS-RORN-DGVKGM-20250521075342

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602093
Report Date: 04/27/2025
Date Signed: 04/27/2025 10:15:11 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
07/18/2022 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20220718153356

FACILITY NAME:	ALTA II		FACILITY NUMBER:	374602093
ADMINISTRATOR:	CHRISTINA GRUBBS		FACILITY TYPE:	735
ADDRESS:	1337 ALTA VISTA DRIVE		TELEPHONE:	(760) 941-0919
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY:	6	CENSUS: 5	DATE:	04/27/2025
		UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	Zoe Wilson		TIME COMPLETED:	10:25 AM

ALLEGATION(S):

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Staff does not provide supervison to resident (s).

INVESTIGATION FINDINGS:

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On 04/27/2025, at 8:00 am, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit regarding the allegation 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 (dateId 2022-2025), needs and services plan (dated 2021-2025), Psychologist assessment (dated 2022-2025). IPP (dated 02/06/2023). 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 two (2) staff members #2-3 (S2-S3). On 04/27/2025, between 8:30 am and 9:00 am, LPA interviewed two (2) staff members #4-4 (S4-S5) and one (1) client (C5).

Unsubstantiated

Estimated Days of Completion:

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

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 3

Control Number 18-AS-20220718153356

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: Staff do not provide Supervision resident (s)

It is being alleged that staff do not provide Supervision to residents, resulting in the resident yelling and bullying other residents. On 04/18/2025, between 9:00 am and 9:30 am, LPA interviewed the administrator (A1), who denied the allegation and stated the facility constantly supervises the resident, especially when they are outside in the backyard playing and doing activities. A1 also stated that the facility always has one (1) or two (2) staff members in the backyard ready to assist the clients in case they need help. 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 member near the client when outside, ready to assist and redirect the client when agitated. On 04/26/2025, between 09:00 am and 10:00 am LPA interviewed four (4) clients #1-4- (C1-C4). 4 out of 4 denied the allegation and stated that the staff are with them a lot. On 04/27/2025, between 8:00 am and 8:30 am, LPA interviewed one (1) client (C5) who denied the allegation. On 04/26/2025, between 11: 00 am and 12:00 pm, LPA interviewed two staff (2) 2 out of 2 denied the allegation, and stated they are constantly with the clients. 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. 04/26/2025, LPA records reviewed of five (5) staff members in service training, and the facility LIC 500 indicated that the facility has three staff members on duty per shift, seven days a week.

Continued LIC9099-C

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 3

Control Number 18-AS-20220718153356

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 04/26/25, between 9:00 am and 10:30 am, LPA Richard observed that three clients were playing outside in the backyard, and there were two staff members outside watching and doing activities with them.

Based on LPA observations, interviews, and record 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 cited. Exit interview conducted. A copy of this 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)

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