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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426083
Report Date: 05/05/2020
Date Signed: 05/26/2020 03:39:56 PM



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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/22/2019 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20190822084754
FACILITY NAME:ATRIA PARK OF VINTAGE HILLSFACILITY NUMBER:
336426083
ADMINISTRATOR:RUSSELL, SAMMYFACILITY TYPE:
740
ADDRESS:41780 BUTTERFIELD STAGE RDTELEPHONE:
(951) 506-5555
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:143CENSUS: 98DATE:
05/05/2020
UNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Bryce Matthews, Executive DirectorTIME COMPLETED:
01:53 PM
ALLEGATION(S):
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Staff failed to safeguard resident's belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Torres, contacted Executive Director (ED), Bryce Matthews, via telephone call to deliver the findings of the above allegation.

Pertaining to the allegation, "Staff failed to safeguard resident's belongings," it was alleged a rolex watch ($4,000), a diamond cross necklace ($1,000), gold hoop earings ($200), monies ($200) and a wallet were taken from the bedroom of Resident One (R1) and Resident Two (R2) in the year 2018 and facility staff did nothing to resolve the matter. On August 27, 2019 the LPA initiated the investigation into the above allegation; the LPA conducted staff interviews, reviewed records and took copies of pertinent information. Interviews could not provide any diffinitive information on whether or not the items were or were not taken. Records review revealed a Client/Resident Personal Property and Valuables inventory was on file for R1 and R2, however a note on the record indicated it was requested for the valuables/property not to be included on the inventory by a third party individual. In addition, a Resident Theft and Loss Record was found to record jewlry and a wallet to be lost, stolen or missing on 09/20/2018 with a note indicating police were notified and an incident report filed. Based
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2020
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
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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/22/2019 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20190822084754

FACILITY NAME:ATRIA PARK OF VINTAGE HILLSFACILITY NUMBER:
336426083
ADMINISTRATOR:RUSSELL, SAMMYFACILITY TYPE:
740
ADDRESS:41780 BUTTERFIELD STAGE RDTELEPHONE:
(951) 506-5555
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:143CENSUS: 98DATE:
05/05/2020
UNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Bryce Matthews, Executive DirectorTIME COMPLETED:
01:53 PM
ALLEGATION(S):
1
2
3
4
5
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8
9
Resident's mattress was soaked with urine.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Torres, contacted Executive Director (ED), Bryce Matthews, via telephone call to deliver the findings of the above allegation.

Regarding the allegation, "Resident's mattress was soaked with urine," it was reported the personal mattress of Resident Two (R2) was observed on March 31, 2019 to be soaked in urine and the facility failed to notify R2's responsible party of the condition of the mattress. It was also alleged the mattress may have been soiled since, or prior to, January 2018. On August 27, 2019 the LPA initiated the investigation into the above allegation; the LPA conducted staff interviews, reviewed records and took copies of pertinent information. Interviews could not provide any diffinitive information on whether or not the matress was observed by staff to be soiled. The medical assessments were reviewed for R1 and R2; the assessment revealed R1 was diagnosed with a health condition that may have led to the matress being soaked in urine. R1 and R2 could not be reached for an interview. This allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20190822084754
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
RIVERSIDE, CA 92507
FACILITY NAME: ATRIA PARK OF VINTAGE HILLS
FACILITY NUMBER: 336426083
VISIT DATE: 05/05/2020
NARRATIVE
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preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted with Matthews where this report was reviewed and a copy provided.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 18-AS-20190822084754
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
RIVERSIDE, CA 92507
FACILITY NAME: ATRIA PARK OF VINTAGE HILLS
FACILITY NUMBER: 336426083
VISIT DATE: 05/05/2020
NARRATIVE
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on this information, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted where this report was reviewed with Matthews and a copy provided.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 4