331880776-6-29-2025-18-AS-EMAZ-DKPR9A-20250819124914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 06/29/2025
Date Signed: 06/29/2025 12:40:19 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
02/02/2024 and conducted by Evaluator Deborah Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240202083337

FACILITY NAME:	WESTMONT VILLAGE		FACILITY NUMBER:	331880776
ADMINISTRATOR:	MONYA HENRY		FACILITY TYPE:	740
ADDRESS:	17050 ARNOLD DRIVE		TELEPHONE:	(951) 697-2100
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92518
CAPACITY:	225	CENSUS: 174	DATE:	06/29/2025
		UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Cynthia Cisneros		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility is not maintained in good repair

INVESTIGATION FINDINGS:

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On June 29, 2025, Department of Social Services staff conducted a subsequent complaint visit regarding the above allegation. The Department met with Cynthia Cisneros, Community Welness Director and explained the reason for the visit.
The investigation consisted of the following:
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), Work History maintenance report (dated 6/27/25).
On 6/28/25, the Department and Memory Care Director toured the facility inside and out. The Department conducted 5 staff interviews (S1-S5), Executive Director (A1), and 6 Residents (R2-R7).
On 6/29/25, the Department conducted interview with 1 resident (R1)

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2025

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-20240202083337

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: 06/29/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Facility is not maintained in good repair

The complaint alleges that the automatic push button assessable door did not work to the Trash/Recycle Room, and the automatic push button assessable door outside the entrance/exit nearest resident’s apartment was broken and hasn’t been repaired.

On 6/25/25 the Department interviewed the Executive Director (A1), who denied allegation and stated that she has only been working at the facility for a little over a month, but the automatic push button accessible doors are functioning properly at the present time and there has been no report of any of the automatic doors not properly functioning.

On 6/28/25 during the facility tour the Department tested each automatic push button accessible door and found them to be working properly.

On 6/28/25 between 10:00am and 12:00pm, the department interviewed 5 staff regarding the allegation. Of those interviewed, 5 out of 5 stated the automatic doors are properly working. 1 out of 5 stated that in the past, the doors had not been working but the maintenance person “fixes” the issue “right away.

On 6/28/25 between 1:00pm and 3:00pm the Department interviewed 6 residents. Of the 6 residents 5 out of 6 stated that they had had no problems with the automatic doors in the facility and they had been working properly. 1 out of 6 stated that they have had issues with the doors not working in the past, but admitted that lately, they have been working properly.

On 6/29/25 at 11:15am, the Department interviewed 1 resident (R1) who stated the automatic access door that hadn’t worked in the past is now a “regular door” with no automatic push button. However, R1 stated that R1 can use other access doors (that open automatically when approached) that requires no push button feature allowing R1 to navigate the facility safely.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20240202083337

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: 06/29/2025

NARRATIVE

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On 6/27/25 the Department obtained and reviewed an electronic copy of the Work History maintenance report (dated 6/27/25). The document shows that the automatic push button accessible doors are maintained on a regular basis.

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 Community Care Director, Cynthia Cisneros.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2025

LIC9099 (FAS) - (06/04)

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