331881251-2-12-2025-56-AS-KCLS-DJWV8G-20250725161241

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881251
Report Date: 02/12/2025
Date Signed: 02/12/2025 01:43:58 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
02/06/2025 and conducted by Evaluator Sarina Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250206121636

FACILITY NAME:	WESTHILLS VILLA GARDENS		FACILITY NUMBER:	331881251
ADMINISTRATOR:	ALMA ESPINAL		FACILITY TYPE:	740
ADDRESS:	5466 WEST WILSON ST.		TELEPHONE:	(951) 849-7521
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY:	30	CENSUS: 21	DATE:	02/12/2025
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Administartor Alma Espinal		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not dispense resident’s medications as prescribed.
Licensee did not ensure injections were administered by an appropriately skilled professional.
Staff used resident’s personal medical device on another resident.
Staff did not ensure centrally stored medications were not accessible to residents.
Staff did not assist resident with care needs in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met Administrator Alma Espinal and discussed the purpose of the visit.

During today’s visit, LPA conducted observations, interviewed staff, residents, outside parties and obtained facility records.

Regarding allegation #1, LPA conducted 6 resident interviews. 2 out of 6 residents were unable to respond whether or not they receive medication as prescribed. 4 out of 6 residents informed LPA they receive their medication as prescribed.

LPA conducted 3 staff interviews. 2 out of 3 staff informed LPA they administer medication daily as prescribed. 1 out of 3 staff informed LPA they do not administer medication.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

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 56-AS-20250206121636

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WESTHILLS VILLA GARDENS	FACILITY NUMBER: 331881251
	VISIT DATE: 02/12/2025

NARRATIVE

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Based on LPA's observation and medication review, residents are receiving medication as prescribed by physician.

Regarding allegation #2, R1 is the only resident who requires injections at the facility. An in home LVN nurse attends the facility three times a day to inject R1. LPA conducted 3 staff interviews. 3 out of 3 staff informed LPA they do not administer injections to residents. LPA conducted interview with in home nurse while at the facility and was informed they are the only person to administer injection to R1, LPA also observed in home nurse injecting R1 at the time of the visit.

Regarding allegation #3, LPA conducted 3 staff interviews. 2 out of 3 staff informed LPA residents personal medical device is not used on other residents. 1 out of 3 staff informed LPA they are unaware which residents have a personal medical device. In home nurse informed LPA they are the one to use medical device on R1, and it is not used on any other resident.

Regarding allegation #4, LPA observed centrally stored medications locked inaccessible to residents in care. Three (3) staff informed LPA medication is centrally stored and inaccessible to residents in care.

Regarding allegation #5, LPA conducted 3 staff interviews. 3 out of 3 staff informed LPA they assist residents with care needs in a timely manner. LPA conducted 6 resident interviews, 2 out of 6 residents were unable to answer LPA's question. 4 out of 6 residents informed LPA staff assist with care needs in a timely manner.

LPA obtained pertinent documents indicting the daily care needs that were provided to residents; such as diaper changes, showers, and medication distribution.

Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated; meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted where this report was discussed and a copy was provided to Administrator Alma Espinal at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC9099 (FAS) - (06/04)

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