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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603399
Report Date: 04/09/2025
Date Signed: 04/09/2025 12:21:11 PM

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
06/02/2024 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20240602104312
FACILITY NAME:WESTMONT TOWN COURTFACILITY NUMBER:
374603399
ADMINISTRATOR:DAVID ALSPACHFACILITY TYPE:
740
ADDRESS:500 E VALLEY PKWYTELEPHONE:
(760) 737-5110
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:200CENSUS: 140DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Executive Director, Austin IrwinTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Resident sustained unexplained injuries while in care
Staff did not seek medical attention for resident in a timely manner
Staff did not prevent an altercation between residents
INVESTIGATION FINDINGS:
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On 04/07/25, Licensing Program Analyst (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Executive Director Austin Irwin and explained the purpose of the visit and the elements of the allegations. The investigation consisted of interviews with staff members and residents, records reviews, and a medical record review.

On 06/02/2024, Community Care Licensing received a complaint alleging that Resident 1 (R1) sustained unexplained injuries while in care, staff did not seek medical attention for the resident in a timely manner, and staff did not prevent an altercation between residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
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 8
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
06/02/2024 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20240602104312

FACILITY NAME:WESTMONT TOWN COURTFACILITY NUMBER:
374603399
ADMINISTRATOR:DAVID ALSPACHFACILITY TYPE:
740
ADDRESS:500 E VALLEY PKWYTELEPHONE:
(760) 737-5110
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:200CENSUS: 140DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Executive Director, Austin IrwinTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Staff did not provide records to resident's authorized person
Staff did not provide emergency personnel the correct information for resident resulting in resident being admitted under the wrong name
Staff did not provide language services for resident as agreed
INVESTIGATION FINDINGS:
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On 04/07/25, Licensing Program Analyst (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Executive Director Austin Irwin and explained the purpose of the visit and the elements of the allegations. The investigation consisted of interviews with staff members and residents, records reviews, and a medical record review.

On 06/02/2024, Community Care Licensing received a complaint alleging that staff did not provide emergency personnel with the correct information for R1, resulting in R1 being admitted under the wrong name. It was also alleged that staff did not provide records to R1’s responsible party.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 18-AS-20240602104312
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: WESTMONT TOWN COURT
FACILITY NUMBER: 374603399
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/16/2025
Section Cited
HSC
87506(c)(1)
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87506 (c)(1)
(c) All information and records obtained from or regarding residents shall be ... (1) ...shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative.
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The Executive Director, Austin Irwin stated he will be created a log of the requested documents and when the documents were provided. Documentation will log person(s) requesting forms, and date provided to the requestor. This sign affidavit is due to the LPA by email on COB on the POC due date.
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This requirement was not being met as evidenced by: facility staff did not provide all requested records to R1's POA. This poses an immediate health and safety risk to residents in care.
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Type B
04/16/2025
Section Cited
HSC
87506(b)(1)
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87506 (b) (1)
(b) Each resident’s record shall contain at least the following information:
(1) Resident's legal name and preferred name, as indicated by the resident.
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The Executive Director, Austin Irwin stated he will be create a 2 factor verification by his staff, prior to any resident going to the hospital. This sign affidavit is due to the LPA by email on COB on the POC due date.
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This requirement was not being met as evidenced by: facility staff not providing correct name for R1 to be admitted in the hospital. This poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 18-AS-20240602104312
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: WESTMONT TOWN COURT
FACILITY NUMBER: 374603399
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/16/2025
Section Cited
HSC
87468(d)
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87468 (d)Licensees shall post the personal rights, nondiscrimination notice, and complaint information specified above in English, and, in any other language in which at least five (5) percent of the residents can only read that other language.
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The Executive Director, Austin Irwin stated he will be conducting an in-service training with staff for any residents who speak another language. Training will be provided, regarding language cards and information provided in the resident’s native language. This sign affidavit is due to the LPA by email on COB on the POC due date.
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This requirement was not being met as evidenced by: staff not using language cards for R1 whose primary langauge was not English. This poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 18-AS-20240602104312
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: WESTMONT TOWN COURT
FACILITY NUMBER: 374603399
VISIT DATE: 04/09/2025
NARRATIVE
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On 06/25/2023, R1 was sent out to an acute hospital by staff under the incorrect name. It was advised that R1’s family spent hours trying to locate R1 and was finally assisted by an emergency services operator. R1’s responsible party met with the Executive Director who confirmed that Staff 2 (S2) provided the paramedics with the wrong name. An interview with S2 indicated that S2 mistakenly verified another resident’s name and that the Med Tech confirmed it. S2 gathered the wrong paperwork while waiting for the ambulance. After the family contacted the facility to say they could not locate R1, the facility reviewed the records and realized the mistake. Responsible party was notified and able to locate R1.

Regarding the allegation that staff did not provide records to the resident's authorized person, it was alleged that the facility did not provide Serious Incident Reports (SIRs) to R1’s responsible party. Information obtained from interview with additional witness stated on 03/18/2024 they requested copies of all SIRs, but only received a few. It was also reported that there was an incident in which R1 was choked by another resident and the responsible party was denied a copy of the report. Administrator stated that the Serious Incident Reports were provided to R1’s responsible party on the date of 03/18/2024.

Regarding the allegation that staff did not provide language services for the resident as agreed, it was alleged that the facility did not provide German-speaking services to R1. It was advised that facility administration agreed to provide language cards in order to communicate with Resident, but they were never provided or used. Interviews with the Executive Director revealed that staff used language cards and an app on their phones to translate. Staff interviews indicated that the cards were rarely used. It was also reported that the app began to be used on 06/10/2024. Resident was placed at the facility on 02/28/2023.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 18-AS-20240602104312
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: WESTMONT TOWN COURT
FACILITY NUMBER: 374603399
VISIT DATE: 04/09/2025
NARRATIVE
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Based on interviews and records review, the allegations of staff did not provide emergency personnel with the correction information for the resident and staff did not provide language services for the resident, the preponderance of evidence standard has been met. Therefore, the above allegations are SUBSTANTIATED. This poses a health and safety risk for clients in care. The facility will be cited.

An exit interview was conducted. A copy of this report was discussed and provided to Executive Director Austin Irwin, along with copies of the LIC811, LIC9099D, and appeal rights.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 18-AS-20240602104312
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: WESTMONT TOWN COURT
FACILITY NUMBER: 374603399
VISIT DATE: 04/09/2025
NARRATIVE
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In regards to the allegation that Resident sustained unexplained injuries while in care, it was reported that Resident 1 sustained bruising and cuts on their body. Information obtained from interview with Administrator denied that any staff harmed R1. Administrator stated that he was unsure how R1 sustained the bruising, but noted staff receive ongoing in-service training and refreshers as needed. Information obtained from interview with Staff #1, (S1) revealed that R1 has experienced multiple falls and that the responsible party would be notified before any transfer to the hospital. The falls were documented on the facility’s charting. The falls were reported to Licensing during the time period of 06/28/2023 to 04/19/2024. Interviews with staff denied that R1 was physically abused by staff. Staff stated that Resident sustained injuries due to being in altercations with other residents, as well as unwitnessed falls during the course of R1’s residency at the facility. LPA was unable to obtain any additional information from Resident #1 regarding the allegation due to not obtaining contact.

Regarding the allegation that staff did not seek medical attention for the resident in a timely manner, it was alleged that the facility did not seek medical attention for R1 in a timely manner. It was reported that an incident occurred on 03/18/2024. R1 fell off the couch. Staff notified R1’s POA of R1’s incidents at the facility. The POA confirmed that they declined immediate medical care and did not approve R1’s transfer to the hospital after an unwitnessed fall.

The facility’s incident report showed that the family declined R1’s transport. The POA stated that they had a nurse come out, whom they contracted independently. The POA stated that they came to assess R1 and saw a large gash on R1’s elbow and a bruise on R1's thigh. The POA asked why they didn’t send R1 out, it was stated that the POA would take R1 to the hospital themselves. Interview with the care staff indicted that they contacted the POA as requested and the POA stated that they would have a nurse come check on R1. The Administrator indicated that it is the facility’s protocol to send R1 out if any head injury is suspected and that the responsible party is always contacted. Interviews with care staff revealed that the POA would request staff to contact them before calling for a transfer to the hospital. According to the facility policy, the Med Tech assesses the resident after an incident.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 18-AS-20240602104312
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: WESTMONT TOWN COURT
FACILITY NUMBER: 374603399
VISIT DATE: 04/09/2025
NARRATIVE
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If the resident is able to move and communicate, they will be helped up or left on the floor, depending on the situation. The Med Tech will then call 911, and the responsible party will be notified of any incidents. Interviews were not able to be conducted with R1 regarding the incident, with four attempts to contact R1 on the same dates as above.

Regarding the allegation that staff did not prevent an altercation between residents, it was reported that on December 13, 2023, there was an altercation between R1 and R2. It was reported that R2 pinned R1 under R1’s walker, causing R1 to sustain a skin tear. Information obtained from Administrator stated that R1 would get into altercations with other residents. Information obtained from interviews with staff stated that they did not observe the entire altercation, but separated, redirected, and increased supervision of the residents. Interview with R2 revealed no information due to R2’s diagnosis. Additional information was unable to be obtained from additional residents due to the residents’ diagnosis and residency in memory care. LPA was unable to interview R1 in regards to the allegation. The incident was reported to Licensing.

Based on the information obtained during the investigation, the allegations that R1 sustained unexplained injuries while in care, staff did not seek medical attention for R1 in a timely manner, and staff did not prevent an altercation between residents are unsubstantiated. Although the allegations may have occurred or could be valid, there is not enough evidence to prove that the alleged violations did or did not occur.

An exit interview was conducted, and a copy of this report was discussed with and provided to Executive Director Austin Irwin.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 8