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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 06/28/2025
Date Signed: 06/28/2025 04:02:18 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
10/08/2021 and conducted by Evaluator Deborah Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211008135633
FACILITY NAME:WESTMONT VILLAGEFACILITY NUMBER:
331880776
ADMINISTRATOR:KEITH KASINFACILITY TYPE:
740
ADDRESS:17050 ARNOLD DRIVETELEPHONE:
(951) 697-2100
CITY:RIVERSIDESTATE: CAZIP CODE:
92518
CAPACITY:225CENSUS: 174DATE:
06/28/2025
UNANNOUNCEDTIME BEGAN:
08:03 AM
MET WITH:Judith PierfaxTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff is insufficient to meet resident's needs
Facility staff are not assisting resident with toileting needs in a timely manner
Resident sustained multiple falls while in care
INVESTIGATION FINDINGS:
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On June 28, 2025, Department of Social Services staff conducted a subsequent complaint visit regarding the above allegations. The Department met with Judith Pierfax and explained the reason for the visit.
The investigation consisted of the following:
On October 12, 2021, the Department conducted and unannounced initial complaint visit and obtained the following pertinent documents: R1’s Service Plan (dated: 7/6/21), staff roster (dated 9/5/21 and 10/10/21), R1’s eMAR (for Aug 2021), Unusual Incident Report (UIR) dated 9/18/21 and 9/1/21. It was determined at the time of the initial visit that the complaint required further investigation.
On 6/25/2025, the Department conducted a telephone interview with Executive Director Judith Pierfax (A1).
On 6/27/2025 the Department reviewed electronic copies of the following pertinent documents: Staff schedule and roster (date 6/26/25), Resident roster (dated 6/26/25), Facility’s Fall Policy (dated 3/1/2025), Emergency and call system monitoring policy (date 8/1/24), and Staff training on Resident Rights (dated 1/3/25).
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025
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 5
Control Number 18-AS-20211008135633
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 VILLAGE
FACILITY NUMBER: 331880776
VISIT DATE: 06/28/2025
NARRATIVE
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On 6/25/2025, the Department conducted a telephone interview with Executive Director Judith Pierfax (A1). On 6/27/2025 the Department reviewed electronic copies of the following pertinent documents: Staff schedule and roster (date 6/26/25), Resident roster (dated 6/26/25), Facility’s Fall Policy (dated 3/1/2025), Emergency and call system monitoring policy (date 8/1/24), and Staff training on Resident Rights (dated 1/3/25).

On 6/28/25, at 9:24am, the Department and Memory Care Director (S2) toured the facility inside and out. The Department conducted 5 staff interviews (S1-S5), Executive Director (A1), and 6 Residents (R2-R7).

The investigation revealed the following:

Allegation: Facility staff is insufficient to meet resident's needs

The complaint alleges that “the facility is trying to save money, and they are short staffed.”

On 6/25/25 at 12:26p via telephone, the Department interviewed the Executive Director (A1) who denied allegation and stated that she has only been working at the facility a little over a month, she is certain that the facility has sufficient staff to meet residents’ needs. On 6/28/25 between 10:00am and 12:30pm, the Department interviewed 5 staff (Staff #1-5) regarding the allegation; 4 out of 5 staff denied the allegation and reported that there is enough staff to meet the needs of the residents. On 6/28/25, between 1:30pm and 3:00pm, the Department interviewed 6 Residents (Residents #2-7). R1 no longer lives at the facility. Of the 6 Residents interviewed, 5 out of 6 denied the allegation. 5 out of 6 stated that their needs are taken care of and that they feel that there are enough staff to meet their needs. On 6/28/25, The Department observed sufficient staff present at time of visit. On 6/27/25, The Department obtained, reviewed, and evaluated staff schedules and resident roster (current and week of incident) and found that sufficient staffing is maintained at the facility to meet the residents’ needs.

Based on the information gathered, there is insufficient evidence to support the stated allegation

Although the allegations above 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.

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

DATE: 06/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20211008135633
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 VILLAGE
FACILITY NUMBER: 331880776
VISIT DATE: 06/28/2025
NARRATIVE
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Allegation: Facility staff are not assisting resident with toileting needs in a timely manner

The complaint alleges that when R1 tells the staff that R1 “has to use the restroom,” the staff takes longer to respond.

On 6/25/25 at 12:26p via telephone, the Department interviewed the Executive Director (A1) who denied the allegation and stated that staff are not supposed to take more than 10 minutes to respond to a resident who calls for assistance. A1 further stated the staff are aware of the policy of responding to residents in a timely manner when they call for assistance.

On 6/28/25 between 10:00am and 12:30pm, the Department interviewed 5 staff (Staff #1-5) regarding the allegation; 5 out of 5 staff denied the allegation and reported whenever a resident calls for assistance they help. 5 out of 5 staff interviewed stated that they have never waited too long to assist residents when they call. 5 out of 5 staff stated that they are aware of the Emergency and call system monitoring policy.

On 6/28/25 between 1:30pm and 3:30pm the Department interviewed 6 Residents (R2-R7) regarding the allegation. 5 out of 6 residents stated that staff assist them in a timely manner when they called for assistance.

On 6/27/25 the Department obtained, reviewed, and evaluated the Emergency and call system monitoring policy (dated 8/1/24) which states in part that “It is expected that emergency calls are responded to timely,” and “upon move in the Executive Director or designee will provide all assisted living residents with training on the use of emergency call devises.”

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

DATE: 06/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20211008135633
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 VILLAGE
FACILITY NUMBER: 331880776
VISIT DATE: 06/28/2025
NARRATIVE
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Based on the information gathered, there is insufficient evidence to support the stated allegation

Although the allegations above 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: Resident sustained multiple falls while in care

The complaint alleges that R1 was admitted to hospital due to a fall on 9/1/2021 and R1 allegedly has had multiple falls within the year. Additionally, it is alleged that R1’s medication and chronic condition is making R1 “feel faint” resulting in falls.

On 6/27/2025 at 12:26p, the Department interview A1 who stated that R1 no longer lives in the facility and the facility doesn’t have any records pertaining to R1’s case due to the time frame that the facility is required to keep records (records are kept for 3 years) and this complaint is from 2021. However, during the initial complaint visit on 10/12 /21, the Department obtained copies of R1’s Service Plan (dated: 7/6/21), R1’s eMAR (for Aug 2021), Unusual Incident Report (UIR) dated 9/18/21 and 9/1/21. The Department reviewed the documents listed above which showed that R1 has had a couple falls during that time and the facility took appropriate steps to ensure that R1 was seen by a medical professional and followed up with R1’s primary care physician . It is unknown what was put in place for R1 specifically, due to the lack of information.

The Department obtained and reviewed a copy of the facility’s fall policy (Dated 3/1/25), which includes: Fall risk reduction, environmental safety, and lift assistance

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

DATE: 06/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20211008135633
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 VILLAGE
FACILITY NUMBER: 331880776
VISIT DATE: 06/28/2025
NARRATIVE
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Based on the information gathered, there is insufficient evidence to support the stated allegation

Although the allegations above 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.

There were no deficiencies cited during today's visit.

Exit interview conducted, and copy of report provided to Executive Director Judith Pierfax.

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

DATE: 06/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5