374602093-4-27-2025-18-AS-RORN-DGAMV6-20250502095615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602093
Report Date: 04/27/2025
Date Signed: 04/27/2025 09:47:59 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
10/22/2024 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 18-AS-20241022142435

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:	09:30 AM
MET WITH:	Zoe Wilson		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff physically abused client.

INVESTIGATION FINDINGS:

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On 4/26/25, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Deborah Lee conducted a subsequent complaint visit for the purpose of continuing investigation and to deliver findings. LPA Lee met with Zoe Wilson Administrator who assisted with this visit.

Investigation consisted of:
On 4/10/25-4/21/25, LPA Lee obtained (via email) and reviewed the following documents: Staff roster (dated 4/9/25), Client roster (no date), Physicians reports (dated 6/11/24, 6/6/24, 6/4/24), C1’s Medication Administration Record (MAR) dated June 2024, July 2024, September 2024., Physician’s order (dated 9/17/24).
On 4/18/25 and 4/21/25, LPA Lee conducted telephone interviews with 5 staff (S1-S5) and Administrator Wilson (A1).

On 4/26/25 LPA Lee and Administrator Wilson toured the facility inside and out conducted interviews with 4 clients (C1 -C4).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
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)

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Control Number 18-AS-20241022142435

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 4/27/25, LPA interviewed 1 client (C5), and reviewed C1-C5’s Individual Program Plan (IPP).

Investigation revealed the following:

Allegation: Staff are not dispensing medications as prescribed

The details of the complaint allege that the physician recommended a tapering of Abilify for C1 from10mg to Abilify 5mg on June 13th, 2024, and a stop of Abilify 5mg on July 8th, 2024. It is alleged that the medication was not stopped as of September 13, 2024. The complaint also alleges that in 2022, the time C1 takes the prescribed Levothyroxine 112mcg was not consistent with the doctor’s orders.

On 4/15/25, LPA Lee conducted a telephone interview with Zoe Wilson, Administrator (A1), who denied the allegation stating that C1’s conservator had a private meeting with Psychiatrist and requested medication changes. The prior Administrator was unavailable at the time of planning where the tapering of the medication was discussed. The facility discontinued the medication when Physician’s order came through. A1 stated, “we continued the orders as prescribed until a new order was issued in September 2024.” A1 further stated that “once the changes were made known, and the order sent to us, is when the medication was changed.” Lastly, A1 shared that facility staff receives training on medication procedures: during the on boarding process, hand on training after on boarding, and annually.

On 4/18/25 and 4/21/25 LPA Lee conducted telephone interviews with 5 staff (S1-S5). 5 out of 5 stated that they have always given medication as prescribed and have never given medication that has been discontinued. Lastly, 5 out of 5 stated that they have had medication training but 3 out of 5 was unable to say how often the training is repeated.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
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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Control Number 18-AS-20241022142435

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 4/21/25, LPA reviewed C1’s Medication Administration Record (MAR) dated June 2024, July 2024, September 2024., and Physician’s order (dated 9/17/24). The review of the MAR showed no discrepancies with C1’s medication; the medication was given as prescribed. Additionally, records show that the facility followed the Physician’s order as given on 9/17/24. LPA Lee observed that C1’s MAR was consistent with the Physician’s order.

On 4/26/25, LPA Lee conducted interviews with 4 clients (C1-C4). 4 out of 4 stated that they received their medication on time, and they have not missed a dose of medication because staff didn’t give it.

On 4/27/25, 1 out of 1 client interviewed stated that they receive their medication on time and has not missed a dose of medication because staff didn’t give it.

Based on LPA’s interviews and records reviewed, the preponderance of the evidence has not been met, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

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

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
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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