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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 10/01/2025
Date Signed: 10/01/2025 09:24:53 AM

Substantiated


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
04/08/2022 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220408102211
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: 201DATE:
10/01/2025
UNANNOUNCEDTIME BEGAN:
08:23 AM
MET WITH:Judith Pierfax - Executive Director TIME COMPLETED:
09:40 AM
ALLEGATION(S):
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Staff are mismanaging resident's medications
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted a subsequent complaint investigation visit regarding the above allegations. LPA met with Judith Pierfax Executive Director and explained the reason for the visit.

The investigation consisted of the following: On 4/15/22 LPA Danielson conducted an initial investigation visit. On 9/26/25 LPA Flores interviewed 3 staff over the phone. On 9/29/25 LPA Flores conducted a visit and interviewed 4 additional staff, 11 residents, conducted a medication check for 11 residents, conducted a tour of 11 resident rooms with Moises Rivas Resident Service Coordinator and tested pendant call button/call cord in each room. On 10/1/25 LPA Flores delivered findings for above allegations.

The investigation revealed the following: Regarding allegation: Staff are mismanaging resident's medications. It is alleged residents are not getting their medications as prescribed.

(CONTINUED ON LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
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 6
Control Number 18-AS-20220408102211
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: 10/01/2025
NARRATIVE
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Interviews with 6 out of 11 residents stated to receive assistance with medication by facility staff. 2 out of the 6 residents stated either the staff had run out of the resident’s medication or the facility staff did not provide medication timely. 4 out of 11 residents stated they manage their own medications. 1 out of 11 residents was unable to be interviewed due to cognitive skills. Interviews with staff revealed medication technicians past medication to residents daily based on the physician’s orders. Medication technicians check the medication system and provide the medication to the residents a check mark is noted on quickmar. Medication technicians are responsible for refilling medications for the residents and request refills between 7 to 14 days before running out. Per documents reviewed for resident #1and#2(R1-R2) the residents were able to manage their own medications at the time of the allegations and per medication sheets between March -April of 2022 R2 received their medication daily. Medication review conducted on 9/29/25 revealed residents were missing either routine, as needed, or both medications. Resident #3 (R3) was missing acetaminophen 325mg, and diclofenac sodium 1%. LPA also found a medication bottle with another resident’s name inside R3’s medication bag. Resident #4(R4) was missing Ibuprofen 800mg, and diclofenac sodium 1%. Resident #5(R5) was missing aspercreme lido max 4% patch, antacid-antigas liquid, milk of magnesium, and loperamide 2mg was observed with expiration date of 7/17/25. Resident #6(R6) was missing nano pen needle 32g-4mm, onetouch delica plus 30g, onetouch verio flex meter, onetouch verio test strip, semglee 100 unit/ml pen, alburetol HFA 90mcg inhaler, BD Veo ins .3ml, ondansetron ODT 4mg, onetouch verio mid cntrl soln, Resident #7(R7) was missing acetaminophen 500mg, banophen 25mg, diclofenac sodium 1%, furosemide 20mg, psyllium husk, zeasorb AF 2% powder. Resident #8(R8) had a bottle of ibuprofen 600mg which was not listed on medication list and was missing baclofen 10mg. Resident #9(R9) was missing balmex 11.3% crm. Resident #10(R10) was missing rivastigmine 13.3mg, and lorazepam 1mg. Resident #11(R11) was missing baclofen 10mg, and lidocain 4% patch. Resident #12(R12) was missing polyethylene glycol 3350 powder. Resident #13(R13) was missing senna 8.6mg and had a prescription order of mirtazapine 15mg which is not listed on the medication list. Based on medication reviewed there were missing medications and medication errors for residents. Therefore, this allegation is substantiated.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview was conducted and a copy of this report, LIC 9099D, and appeal rights were provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 18-AS-20220408102211
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/02/2025
Section Cited
CCR
87464(f)(6)
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87464 Basic Services (f) Basic services shall at a minimum include: (6) Arrangements to meet health needs,…

This requirement is not met as evidence by:
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Executive Director will work with nurse and medication technicians to audit the medication and provide training to the medication technicians. Executive Director will provide a copy of training with date, topic, and signatures, and will provide updated medication list or pictures of medication
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Based on medication review conducted the licensee did not ensure medications were available for R3-R13 which poses an immediate risk to the residents health, safety, or personal rights of the persons in care.
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obtained by POC due date 10/1/25.
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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: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
04/08/2022 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220408102211

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: 201DATE:
10/01/2025
UNANNOUNCEDTIME BEGAN:
08:23 AM
MET WITH:Judith Pierfax - Executive DirectorTIME COMPLETED:
09:40 AM
ALLEGATION(S):
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Staff do not respond to resident's call for assistance in a timely manner
Resident's do not have access to a telephone
Staff do not assist residents with required blood pressure checks
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted a subsequent complaint investigation visit regarding the above allegations. LPA met with Judith Pierfax Executive Director and explained the reason for the visit.

The investigation consisted of the following: On 4/15/22 LPA Danielson conducted an initial investigation visit. On 9/26/25 LPA Flores interviewed 3 staff over the phone. On 9/29/25 LPA Flores conducted a visit and interviewed 4 additional staff, 11 residents, conducted a medication check for 11 residents, conducted a tour of 11 resident rooms with Moises Rivas Resident Service Coordinator and tested pendant call button/call cord in each room. On 10/1/25 LPA Flores delivered findings for the above allegations.

The investigation revealed the following: Regarding allegation: Staff do not respond to residents’ call for assistance in a timely manner. It is alleged staff do not respond when pendant button is called.

(CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 18-AS-20220408102211
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: 10/01/2025
NARRATIVE
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Interviews with residents revealed 9 out of 11 residents stated the facility staff respond to the pendant call. 6 out of the 9 residents stated time of responds varies from 15-30 minutes. 2 out of 11 residents were either unable to answer due to cognitive skills or have not used the pendant call button. Interviews with staff revealed staff respond to the pendant call as soon as they are available. Per the staff facility’s policy is to respond to residents calls within 10 minutes. On 9/29/25 LPA observed 11 random resident rooms and tested either the pendant call button that residents carried or the pull cord in the residents’ bathroom. Caregivers responded within 2-10 minutes. Facility’s policy does not provide a time frame in which staff should respond to calls. Documents reviewed for R2, pendant call log between April 3rd-15th, 2022. R2 used the pendant call twice, staff cleared the pendant calls as follow; the first one within 23 minutes and the second one within 17 minutes.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation: Resident's do not have access to a telephone. It is alleged residents are in a shared unit with no phone access. Interviews with residents revealed 10 out of 11 residents stated to have either a landline or a cellphone to make phone calls. 1 out of 11 residents was unable to answer due to cognitive skills. Interviews with staff revealed residents have a phone in their rooms. Per staff, residents are encourage to obtain a free government cellphone if necessary, and they can also ask the front desk person to assist them with making calls if necessary. On 9/29/25 LPA observed either a landline, a cellphone, or both in each resident’s room toured.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation: Staff do not assist residents with required blood pressure checks. It is alleged facility staff are not regularly checking residents’ blood pressure. Interviews with residents revealed 1 resident stated that they required blood pressure checkups. However, the facility is not responsible for providing that care and a private nurse provides that care for them. The other residents stated they either don’t require the services or are aware that the facility does not provide medical services. Interviews with staff revealed the facility does not provide medical services. (CONTINUED ON LIC 9099C)
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20220408102211
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: 10/01/2025
NARRATIVE
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Therefore, blood pressure check-ups are not a service they provide to the residents in care. Staff upon observation of a change in condition follow the facility’s protocol to notify medication technician for evaluation, or physician.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6